PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT iv?rfi�7))
Date: glo
,,
er -
Owner: Builder
Address Address
;r CA 10 BUILDING
No. —� Street F Lot —
Lot _ Block Addition or Sub.
Corner Lot � hack Sideyar
Sewer Elevation ____ _ _ Foulfdation Elevation
DESCRIPTION OF BUILDING
Toas:
Kir". Front _ Depth _+ Height a€ Sq. Ft. Cu. Ft.
t DepthHei ht, zr Sq. Ft. Cu. Ft.
Type of Construction Est.. Co _ To be Completed
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $AWW_ , 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 workmen, in all work
done in, around and upon said building, or anypart thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits ndht s permit may be revoked at any time upon violation of any of the provisions of said
ordinanCe& a —,&
Building Inspector
NOTICE:
This peemh don not ewer the construction, 6uta1lafion for v Wn& 'iumbino, gas bales, sawn or water. Be wro to we
the BwMins kwecwr for separate parmht for thea home.
f
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Nam ilder
Address Address
LOCATION Of BUILDIN
Noy Street art
Lot Block Addition or Subd vision
Corner Lot Inside Lot '9ftb
SEWER
of Lot
P
Side -Yard 3
ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
T b us d as:
Front v� Depth eight�!_�i
Sq. Ft. Cu Ft.�
Front Depth Height
QSq. Ft. Cu. Ft.
Type of Construction Estimated Cost
11.01 L-011
To be Completed
The undersigned hereby makes application for a permit for the work herein
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. _ '_—� /9
(Schedule of Fee Costs can be found on the Reverse Side).
- • - r
BUILDING PERMIT FEE SCHEDULE
Section 2, The Inspector of Buildings shall, before issuing any permit for
the erection of any building or structure, or for any addition to any exist-
ing building or structure, or for any alterations or repairs to any existing
building or structure, upon application therefor, 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;
2.1. For any such permit for the erection''of any fire -proof building, other
than a garages warehouse, factory or grain elevator, or for the erection of
any fire -proof addition, for similar occupancy, to any existing building
shall be at the rate of $i.40 for each one thousand cubic feet, or fraction
thereof, in such cubical contents..
2.2. For any such permit for the erection of any fire -proof garage, warehouse,
factory or grain elevator, or for the erection of any fire -proof addition,
for similar occupancy, to any existing building shall be at the rate of $1.25
for each one thousand cubic feet, classified as "fireproof1° by Section 502 of
the Minneapolis Building Code. -
HOUSES
2.3. For any such permit for the erection of any non -fireproof building other
than a garage, warehouse, factory or grain elevator, or any non -fireproof
addition, for similar occupancy, to any existing building - permit $1.00 for
each one thousand cubic feet.
GARAGES
2.4. For any such permit for the erection of any non -fireproof garage,
warehouse, factory or grain elevator, or for the erection of any non -fireproof
addition, for similar occupancy, to any existing building or for each such
building or addition - ninety cents ($0.90) for each one thousand cubic feet
or fraction thereof, in the cubical contents thereof with a minimum of $4.00.
For the purpose of computing fees for building permits, the cubical contents
of any building or addition to a uniform height throughout by multiplying the
ground area covered from a point.six;(6) inches below the floor line of the
basement or cellar to the average height of the upper surface or to the
average height of the roof surface of the main gable of a pitched roof.
2.5. 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 -proposed work.
2.6. In no case shall the fee charged for any permit as set forth in
Section 2 be less than $4.00.
- - r
6438 LFOXVUSUrg AV H� E
yR%gLLr)T , m SOU 53421
560-34,50
Mr. Bruce Chrysler
420 Liberty St. N. E.
Fridley, Minnesota 55432
December 13, 1966
as-* UVAULng Fermat Be. 6179
l as *ndo �cteber 9 + 19da
Addy so
For.. no. 41i*-- U., nQ
i&&Q Siro
Phis office hae been inforod by the City Aasessar that the work
tlimed an the above captimed building Pa mit has not as yet been
c=pjeted. As you know, a buiidimg pamit is vaBid for a me year
sriod fres the date it waa issued.
UWLY Bet in touch with this offico for rawma8 of this Pe mit
before jamary 1, 19677. It any ch"gag of dtaign or eatent of work
are pLamed, pteaae submit thin Infvrmstiop a1mg with estimated
cost of lama acs that caul reeords will correspond with the City
A®aea�s®r's o
If there are any quepti@m with refereace to this msttcr® kindly
catt this effict.
Tours very truly,
CBecks
City of Fridley
Application for Plumbing and Cas Pitting Penult
DePL of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures ....... ..............
x
$1.50
$
Future Fixture Opening ................
x
1.20
$
New Fixture Old Opening ..............
x
1.00
F
N
WATER HTR.
GAS
ELEC.
Water Heater (Up to 200,000 BTU) ......
x
2.00
$
New Ground Run Old Bldg . ............
x
3.25
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
x
$1.50
O
Additional Fixtures ... 1 ................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
Base
1st
2nd
_
3rd
4th
• Future Connection Openings
Connected with
I
-Sewer �
New Fixture, Old Openings
Cesspool El
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures ....... ..............
x
$1.50
$
Future Fixture Opening ................
x
1.20
$
New Fixture Old Opening ..............
x
1.00
$
Catch Basin ...... .....................
x
3.25
$
Water Heater (Up to 200,000 BTU) ......
x
2.00
$
New Ground Run Old Bldg . ............
x
3.25
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
x
$1.50
$
Additional Fixtures ... 1 ................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
REPAIRS & ALTERATIONS --Refer to Code
Description ................................................$ -
TOTAL FEE •
a
City of Fridley:
a
)2.
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do 411 work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley,
Owner
Kind of Buil inj�
Used as
To be completed about
4
Estimated Cost, $
Old—Adevr.–Building Permit No Pe N
G
110
Sign
ROUGH
FINAL
-OJEDOAR 2M 7-59
Business Phone N
19_
_/ ef`3�4
City of Fridley, Minn. 9572
BUILDING PERMIT
Date: Dec. 4, 1967
Owner: Bruce Chrysler Builder Same _—
Address 420 Liberty St. N. E. Address Same
LOCATION OF BUILDING
No. 420 _ Street .—_. Liberty St. � Part of Lot
Lot 32 & 33 _ Block 7 Addition or Sub -Division . Spring Brook Park
Corner Lot — Inside Lot — Setback --_ Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Rear Entry Front _ _ 14' Depth 81 Height — 8 t Sq. Ft. Cu. Ft.
Front Depth Height — Sq. Ft. Cu. Ft.
Type of Construction Frame _Est. Cost_ $500.00 __ To be Completed 3/1/68
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in complian with allprovisions of
ordinances of the city of Fridley. �� f7 // _
In consideration of the payment of a fee of $ 5.00 , permit is hereby granted to_._. Bruce Chrysler
to construct the building or addition as described above. This permit is granted upon
j
ress condition that, around anduMinnesota regarding location, construction, alteration, mainte/nva�nce, repair and moving of buildings
e city limits and this permit may be revoked a t a�iv time u�� / $ of th provisions of said
Official
REPWW
NOTICE:
This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be euro to sse
the Building inspector for separate permits for these Henm
r r . 4
APPLICATION FOR BUILDING PERMIT
CITY. QF, :FRIDIEY, MINNESOTA
00
OWNER'S NAME rose.
ADDRESSIi3RESS vr_ +�,1
LOCATION OF BUILDING
NO
LOT13LOCK ADDITION OR SUBDIVISION..._. RR
CORNER LOT INSIDE LO SETBACK 41
SEWER ELEVATION TOP OF FOOTING
Applicant attach,to this form Two Certificates of Spivey of Lot and proposed
building Atocation drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
deser- &P/ Z#- fe Front AV Depth,_„
Square feet %'jam Cubic Feet.-
Front
eet..
Front Depth Height
Square feet Cubic Feet
Type of Construction Estimated Cost
To Be Completed
The undersigned hereby makes application for a permit for the work herein
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.
DATE —SIGNATURE .•.
(Schedule of Fee Costs can be found on the Reverse Side).
a �f�
1
d
CfiYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
May 6, 2002
Michael Taylor & JD Penny
420 Liberty Street NE
Fridley MN 55432
Re: Paved Driveways
Dear Propery Owners:
In 1997, the City Council adopted an ordinance declaring gravel driveways a public nuisance.
They were declared a public nuisance for a number of reasons, such as: they can cause
erosion, contaminate soil with oil and other vehicles fluids, and deposit soil and gravel in the
City's storm sewers and detention ponds. When gravel driveways were declared a public
nuisance, the City Council gave property owners five years to have their gravel driveways
paved. The five-year deadline is quickly approaching, which means all gravel driveways within
the City of Fridley must be paved with approved concrete or asphalt by December 31, 2002.
If on December 31, 2002, your driveway hasn't been paved a citation will be issued and filed at
the Anoka County Courthouse. A misdemeanor citation is a criminal offense and is punishable
by up to 90 days in jail and/or a $700 fine.
If you've already paved your driveways, Thank you! Please call me at 763-572-3595, so I can
update our files.
For your convenience, a brochure on the City's loan program has been enclosed. You can use
this loan program to acquire financing for your driveway improvement project. Please call Jim
Hesnik at 612-335-2651, if you have any questions regarding this program.
Thank you for your cooperation! As you successfully complete your driveway improvement
project, please call me at 763-572-3595, so I can do an inspection of your property and update
our files. If you have any other questions, please feel free to call meat the above number.
Sincerely,
Stacy Str berg
Planner
C-02-53
CIIYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 - (763) 571-3450 - FAX (763) 571-1287
July 2, 2002
Michael Taylor & JD Penny
420 Liberty Street NE
Fridley MN 55432
Subject: Paved Driveway Reminder
Dear Propery Owners:
This letter is a friendly reminder that all driveways within the City of Fridley need to be paved by
December 31, 2002*.
As you are aware, the City Council adopted an ordinance declaring gravel driveways a public
nuisance. They were declared a public nuisance for a number of reasons, such as: they can
cause erosion, contaminate soil with oil and other vehicles fluids, and deposit soil and gravel in
the City's storm sewers and detention ponds. When gravel driveways were declared a public
nuisance, the City Council gave property owners five years to have their gravel driveways
paved. The five-year deadline is quickly approaching, which means all gravel driveways within
the City of Fridley must be paved with approved concrete or asphalt by December 31, 2002*.
If you've already paved your driveways, thank you! Please call me at 763-572-3595, so I can
update our files.
For your convenience, a brochure on the City's loan program has been enclosed. You can use
this loan program to acquire financing for your driveway improvement project. Please call Jim
Hesnik at 612-335-2651, if you have any questions regarding this program.
Thank you for your cooperation! As you successfully complete your driveway improvement
project, please call me at 763-572-3595, so I can do an inspection of your property and update
our files. If you have any other questions, please feel free to call me at the above number.
Sincerely,
S om erg
Planner
If on December 31, 2002, your driveway hasn't been paved a citation will be issued and filed at the Anoka County Courthouse. A
misdemeanor citation is a criminal offense and is punishable by up to 90 days in jail and/or a $700 fine.
C-02-83
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
x631572-3604 FAX: (763) 571-1287
ADDRESS
: 420 LIBERTY ST NE
PIN
: 033024310076
LEGAL DESC
: UNAVAILABLE
: LOT BLOCK
PERMIT TYPE
: BUILDING
PROPERTY TYPE
: RESIDENTIAL
CONSTRUCTION TYPE
: GARAGE, DETACHED
PERM O.:2004-01668
DATE ISSUED: 09/24/2004
VALUATION : $ 18,069.00
NOTE: CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. PROVIDE HARD SURFACE DRIVEWAY.
SEE NOTATIONS ON PLAN. REMOVE EXISTING GARAGE. CONSTRUCT A 26'X 22' DETACHED
APPLICANT
TAYLOR MICHAEL & PENNY DELUCE-
420 LIBERTY ST NE
FRIDLEY, MN 55432
OWNER
TAYLOR MICHAEL & PENNY DELUCE-
420 LIBERTY ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating c6struction.gr tyle performance of constrgction.
Insp.
BUILDING PERMIT FEE 307.25
PLAN CHECK FEE 199.71
FIRE SURCHARGE 18.07
STATE SURCHARGE, VALUE 9.03
TOTAL 534.06
PAID WITH CHECK # 4014
SEPARATE PERMITS REOUIRLD FOR WORK OTHER THAN DESCRIBED ABOVE.
AUG -16-2004 09:47 CITY OF FRIDLEY�'� _ �J,/ P.02iO3
1*4evv l) CITY OF FRtDL r 1� Ef dive 411/2004
ADDN 1 l 6431 University Ave NE, Fridley, MN 55432 (763) .3604 aft Iris
ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
(763) -1287' F�1X
BUILDING PERMIT APPLICATION
j
Construction Address: L e . a
Legal Description: 4
Lac
Owner Name & Address: Tel. #
Contractor. �� _ MN LICENSE #
Address: Tel. #
Attach to this application, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length , Width _ Height n Sq. Ft 0_
DECK AREA; Width "' and Sq. Ft
OTHER: ✓4 �s X
Construction Type: Estimated Cost: $ /5 O
r
Driveway Club Cut Width Needed: Ft + 6 Ft = Ft x $
DATE: T— APPLICANT:.4 ATel. # �/_� � 1' D03
6W
Call (763) 312.3604 for Permit Fees if mailing in a iication. Fax to 763-571-1287 if using credit card and we will calf
you for card number.
CITY use ONLY -
Permit Fee
Plan Review
Fire %mfarge
Statertum1 arge
SAC Phai"
License. 6urcharge
Curb CutEscrow
Erosion Control
Park F'pq
Sewer Main Cham
Fee Schedule on Reverse Side
66% of Permit Fee
.001 of Permit Valuation (1110th%)
$.50/$1,000 Vakiation
$1350 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 [ j Not Necessary [ )
TOTAL $ 53q, STIPULATION;
Building
$
BUILDING
Plan Review
Permit No.: o ®® -0/
Inspections
Surcharge
RESIDENTIAL APPLICATION
(.0005) times the total job valuation — Minimum $.50
Received By:
763-572-3604
$ 001 x Permit Valuation (1/10%)
CITY OF FRIDLEY
$
Date Rec'd:
DATE —
YOUR E-MAIL AQD SS
$1450 per SAC Unit (Plans to MWCC for determination)
SITE ADDRESS
$
ft + 6 ft = ft x $20 = $
THIS APPLICANT IS:
f�9WNE ❑CONTRACTOR
$450 Conservation Plan Review
PROPERTY OWNER/
NAME:
Fee Determined by Engineering
TENANT
ADDRESS: S CITY
STATE, C U
Total Due
PHONE: 62i Al
v Make checks payable to: City of Fridley Attach Stipulations
CONTRACTOR
NAME: --4\44)
SUBMIT A COPY OF
STATE LICENSE # EXP DATE
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
GLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHEDWINDOWS
❑ BASEMENT FINISH 11 ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW _❑gD01 ION
❑ MAINTENANCE/REPAIR MODELING
DESCRIBE WORK BEING DONE: I
SIZE OF IMPROVEMENT LENGTH WIDTH aq
HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
Existing Floor Plan
PROPOSED SIZE:
❑ DETACHED GARAGE
2•
Proposed floor plan
PROPOSED HEIGHT:
3.
List of structural members to be used
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
I.
Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS KYes [No LOCATION OF WINDOWS baSZ wola
3.
Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED CJQffCA5 NUMBER OF WINDOWS
ALL FEES ARE BASED ON VOILUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING, THE R97 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ ® OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Surcharge
$
(.0005) times the total job valuation — Minimum $.50
Fire Surcharge
$
$ 001 x Permit Valuation (1/10%)
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $20 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary( ) Non Necessary ( )
Total Due
$
v Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID 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
permit but only an application or a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work w 'ch require view and approval of plans. p c
SIGNATURE OF APPLICANT ( PRINT NAME l DATE K -
a
2
3
z
O
3
p
1,
V�
c
2
3
z
O
1,
V�
Ell
9-29-2005 2:24PM FROM LAW OFFICES 1 651 490 2904
,P.ENNY DELUCE
420 Liberty Street N.E.
Fridley, UN 55432
Telephone (763) 784-4926
Facsimile (651) 490-2904
September.' ), 2,105
City of Fridley
Building Permit Division
Fridley, NIN 55432
RF: Building Permit 0#2004-01668
Dear Sir or Nladam:
This letter is to request an extension of my building penin for my garage. All 1 have
rrmminino Arr• the c,grAge. and ,ervico doors. the cid)'nu and the f -k xrical. The , idinr i,,, beino
delivered next week and the garage I would like a one month c:x cnsion to have all the work
completed.
I1' you have any questions, please feel free to contact Mi,.
Sine lye
oe"
L ..J
Penny J. Dt;1 ce
P. 1
i2 -1�y ys-
•
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIA I ,S:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 16`97. 4 Li OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ (—f
$ J CCAS
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determinati , t)
ft+6ft= ftx$21 =$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Ai t tch
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; hat the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; tht . I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in ace, ,i dance with the approved
plan in the case of all work w 'Gh requ' e� r/evvie and approval of plans.
SIGNATURE OF APPLICANT GJ/ 1�% PRINT NDATE_/IZ�8�
I
J
BUILDING7
Permit Jo.:
ReceiV d By. P s5
Building
Inspections
RESIDENTIAL APPLICATION
763-572-3604
CITY OF FRIDLEY
Date R c'd:
DATE
YOUR E-MAIL ADDRESS
SITE ADDRESS
!�
THIS APPLICANT IS:
❑ OWNER ONTRACTOR
PROPERTY OWNER/
NAME: Gtl%I
--
ADDRESS: =
_ST TE ---ZIP
TENANT
PHONE: '%do G • �Sg `�
CONTRACTOR
NAME: r 111 .-
— ---
"�1
STATE LICENSE it VO L�� pry,, EXP DATE 5110 0 A i
S-&1/7 "� : W, CITY ���r ' STAT
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS:I'1lim e r r =S
-
WITH APPLICATION
PHONE /f6/- '9. FAX 6161- AO
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ 9ARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH 514ROOF ❑ DRAIN TILE
❑ DECK /❑ SIDING ❑ OTHER
❑ SWIMMING POOL
—_
TYPE OF WORK:
ADDITION
MAINTENANCFJREPAIR REMODELING
DESCRIBE WORK BEIN6
DONE: a.,?
SIZE OF RAPROVEMENT LENGTH WIDTH
HEIGHT_ _ Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GARAGE
BASEMENT REMODEL) 'G SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
2.
Existing Floor : in
Proposed floor an
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structur, I members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCT ; >N INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS
& P0RCW ` SUBMIT:
❑ Aluminum
❑ Trim
1.
Site Plan/Surve showing the existing structures
❑ Other
❑ Fascia
and proposed p ject.
2.
Two sets of cot ; ruction plans
WINDOWS
3.
Energy Calcula ; >ns
IN EXISTING OPENINGS OYes 13No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIA I ,S:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 16`97. 4 Li OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ (—f
$ J CCAS
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determinati , t)
ft+6ft= ftx$21 =$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Ai t tch
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; hat the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; tht . I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in ace, ,i dance with the approved
plan in the case of all work w 'Gh requ' e� r/evvie and approval of plans.
SIGNATURE OF APPLICANT GJ/ 1�% PRINT NDATE_/IZ�8�
I
J
Building
BUILDING
Permit No.: �
Inspections
RESIDENTIAL APPLICATION
Received By: ,
763-572-3604
CITY OF FRIDLEY
DaM (NOV 7
763-502-4977 FAX
EFFECTIVE 1-1-08
DATE •— 1 0
YOUR E-MAIL ADDRESS
SITE ADDRESS
1 C
THIS APPLICANT IS: ❑ OWNER ReONTRACTOR
PROPERTY OWNER/
NAME:
TENANT
ADDRESS: !� CITY i
�/
STATE /�=x"IP
PHONE:
NAME: r- P — /
ADDRESS: d CITY
P STATEJ!(%&_CQ��
CONTRACTOR
SUBMIT A COPY OF
PHONE G Zk �t ff f 3 FAX
YOUR STATE LICENSE
STATE LICENSE # c200> EXP DATE
? J/ —Z52
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH❑ OF ❑ DRAIN TILE
13 DECK RIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
BASEMENT
REMODELING SUBMIT:
NUMBER OF SQUARES
❑ HOUSE & GARAGE
1. Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List
of structural members to be used.
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
ADDITIONS,
& PORCHES SUBMIT:
❑ Vinyl
[]Soffit
1. Site Plan/Survey showing the existing structures
❑ Aluminum
❑Trim
and proposed project.
❑ Other
❑ Fascia
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
_
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
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 Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1825 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 payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID 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; th9t I understand this is not a permit but only an application for a permit and work is not to start without a
permit on site; that the work will be in accord with a approv the case of all work which requires review and approvallf plans.
1 PRINT NAME Z 04 n /c �% P- I >^ DATd' _"�
SIGNATURE OF APPLICA liV �.
I log