PRE 2010 DOCSCity of Fridley, -Minn.
BUR DING PERART
Date: ...1.0.s'�p.0.-. ,)- �.......
Ader
dress .......................................
N® 3518
Builder
Address....................
.................. .
LOCATION OF BUILDING
No. Street . .:..... PartAoz4f.�..-
Lot
..........
..3...... Block ....3.......... Addition or Sub -Division....
c
Corner Lot ............ Inside Lot .Jir ......... Setback-��:.�. � � . Sideyard �� . ,.0 .'.............. .
DESCRIPTION OF BUILDING
To Used ,(% P.t— /
P.Gdz ....... ... Front .. `. !. Depth ' s : " c f Height K7 Sq. Ft. 104Y cu. Ft. Z ® Q ZLS
.................... Front ........Depth ........ Height ........ Sq. Ft......... Cu. Ft........ .
Type of Construction ................• • BBL Cost.�cR 7Z.. .. To be Completed
In consideration of the issuance to me of a permit to
the proposed work in accordance with the description ab
ordinances of the city of Fridley.
desribed above, I agree to do
ompliance with all provisions of
In consideration of the payment of a fee of $q. ..'�.. 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 any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, p! , gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these ma
City ®f Fridley, Minn.
BUILDING PERMIT N° 6982
Date:
Owner: — Builder
Address Address
LOCATIO -BUILDING
No. Street, n Part of Lot
Lot --- Block Addition or Sub- n
Corner Lot _ Inside Lot aback fl-&#�ftMdeyard _..
Sewer Mevation — Fo dation IIevation
DESCRIPTION OF BUILDING
T as:
t —`Depth "eight ZV Sq. Ft. 4vcu. WAW
'ont Depth eight Sq. Ft.____ Cu. Ft
Type of Construction _.._. _ _. Fist.. -----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 compliance with all provisions of
ordinances of the city of Fridley. /�
In consideration of the payment of a fee of $���p— , 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 any part 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 and this permit may be revoked at any tune upon violahtern of any of the provisions of said
ordinances. /'1 0 „
Building Inspector
NOTICE
Tbis permit does not cover the construction, butalladon for whiny, phanbing, ga boding, sora or water. Bo oro to we
the Building Inspector for separate permih for these beets.
City of Fridley
SUBJECT
®i353
AT THE TOP OF THE TWINS
PERMIT
BUILDING
R O.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
�
1 �
ttt
`
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
5/20/76
JOB ADDRESS 6810 Monroe Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
3
3
Brookview Terrace SHEET
2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE
Frank Ferguson 6810 Monroe Street N.E.
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
Bruneau Construction
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 CX ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 22' x 20' addition to.existing ara e
9 CHANGE OF USE FROM TO
STIPULATIONS
provide frost footings
REQUIRED FOR WRING,
5EPE RATE PERMITS
PLUMBING AND SIGNS.
HEATING,
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
Wood Frame
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
R-1
44O
4400
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 GOVERNING THIS TYPE OF WORK WILL BE COMPLIED,
$3.256
1.63
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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.
$8.50
PLAN CHECK FEE
TOTAL FEE
$10.13
n SIGNA NTRACTOR QB AUTENT (DATE)
WHEN PROPS LY VALIDATED THIS IS YOUR PERMIT
t
N
BLDG. INSP DA E
N EO OWNERI N B DER (DATE
6 r_w^
M - E G
ENGINEERS AND SURVEYORS
;-AND SOILS TESTINGS
Zl',/lL &. M.VNICIPAl- LANO PLANNING
G418-56*Tw AVENUE N.
MINIMEA,PCL15 TLMIMN-
KE 7- 3G37
Q�
PP, PZE 5 E 1 NT 10 �.l OF N Sk)L)V E Y OF THE E50tJWDPRlE5 0.r_ THE
1, p, P.C.CT - -1 , I
-5, IF P,,M[) PLL V611BLE ENCROA-CHIvI
AND 1
0.'�D
ORL ON �INNZ CO., INC.
svp-ve-4109-5
t-z -
.22
Q�
PP, PZE 5 E 1 NT 10 �.l OF N Sk)L)V E Y OF THE E50tJWDPRlE5 0.r_ THE
1, p, P.C.CT - -1 , I
-5, IF P,,M[) PLL V611BLE ENCROA-CHIvI
AND 1
0.'�D
ORL ON �INNZ CO., INC.
svp-ve-4109-5
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S . NAME : yam/' : At SU •h BUILDER : ,dr cf n p a. j. �o n . r y- w r- U a a
ADDRESS:C����
//�l7 / e SX ADDRESS.:�i-T---
%j � L
STREET:
LOT: BLOCK: 7� ADDITION,
CORNER LOT: INSIDE LOTSETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
e f�x nInlil- Depth • -' 0 Height • &I
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction. • z
C� a
stimated
Cost:
To Be
j 2
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:
(See else Side For Additional Information.)
L
SUBJECT
PERMIT NO.
City of Fridley
-q
AT THEIr ? TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
10-�r53
�
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
4/27/95
/ /
JOB ADDRESS 6810 Monroe Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3
3
1 Brookview Terrace
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Frank Ferguson 6810 Monroe Street NE
571-2039
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (25 Sq) Tear-off except on garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building
Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
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 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
1
I STALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,875
$.94
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-
SC
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$43.00
Fire $1.88
PLAN CHECK FEE
TOTAL FEE
$45.82
WHEN PROPER VALIDATED THIS IS YOUR PERMIT
I ATU'�EOFCON7RA,T�AUTORIZEDGENT I AM
'jj�t
F)ATE11
S,GNATUBE OF OWNEDI F OWN UILDERI IDA
NEW i ]
•ADDN
-ALTER [.]
Construction Address-:
. CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES. R-1 AND R-2
Building Permit Application.
Effective 1/l/95
' . L,gal Description:
Owner Name '& Address r� )C fie �g.i.► s� Tel.. # 7/ = :' cJ 3.
Contractor.: (< re r y MN LICENSE #
Address: olgid .we.,.raTel. # 5,71 - 2_6 9.
Attach to this application,. a Certificate of Survey of the `
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length
Width _
Height
Sq. Ft.
GARAGE AREA! Length
Width
Height
Sq. Ft.
DECK AREA: ..Length
'Widths
Hgt/Giound
-S�jq. 'Ft.
OTHER:
G< roll C:: -
Comer Lot [ ] Inside Lot k] Ft. Yd Setback Side Yard Setbacks
Comer
Type of Construction:
L .•,• Qno P Estimated Cost: $ �c� %�_
Approx. Completion Date: n,,,,r 70
T
(Cost on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
i / )' APPLICANT:
DATE: APO
Tel. # 571-2-d3?
CITY USE ONLY
Permit Fee
$ J. 610
Fee Schedule on Reverse Side
Fire Surcharge
$ / , n
.001 of Permit Valuation (1 / 10th %)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$850 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary ( ]
TOTAL
STIPULATIONS:
w
110
sueaEcr
PERMIT NO.
City of Fridley
2345 �
AT THE TOP OF THE TWINS
BUILDING
P E R M I T
f
RECEIPT NO.
1.______ COMMUNITY DEVELOPMENT DIV.
L
r PROTECTIVE INSPECTION SEC
2_c)
i
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
6/12/95
JOB ADDRESS 6810 Monroe Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3
I
3
1 Brookview Terrace
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Frank Ferguson 6810 Monroe Street NE
571-2039
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ALTERATION j] REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
New windows, doors, siding
9 CHANGE OF USE FROM TO
STIPULATIONS
Windows being replaced in the bedrooms must meet the State Egress
Code. Provide smoke detectors by all bedrooms.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY 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 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 CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$8,000
$4.00
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
$99.00
Fire SC $8.00
PLAN CHECK FEE
TOTAL FEE
111.00
OF 'FACTOR ORIZEDAGENT )DATE)
WHEN PROPERLY V (DATE THIS IS YOUR PERMIT
BLD )NSP
SIGNATURE OF OWNEROfCWNER B DER) (DATE)
110
NEW ( ]
ADDN [ ]
ALTER []
Construction Address:
Legal Description:
Owner Name & Address:
Contractor:
Effective 1 / 1 /95
.. CITY -OF . FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
`'�)G��oe
Tel. #
MN LICENSE # '
Address: 6 �/� - �l/ '17 r //� �� Tel. #
Attach to -this application, 'a Cdrtificate -of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA:
Length
Width Height Sq. Ft. _
GARAGE AREA:
Length
Width Height Sq. Ft.
DECK AREA:
Length
Width Hgt/Ground Sq. Ft.
OTHER:
,/� �.///
d r2a""j < i' Jq "'r
Corner Lot [ ] Inside
Lot (j Ft. Yd Setback Side Yard Setbacks
Type of Construction:
Estimated Cost: $ J,DO G
Approx. Completion -Date:
(Cost on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
DATE:
APPLICANT:
Tel. #
CITY USE ONLY
Permit Fee
$ ��
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$850 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
$ ��
STIPULATIONS:
f �� •'`.�
a s
fir: S _$•'
..j.:W ,...
CINOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
June 27, 1995
Mr. Frank Ferguson
6810 Monroe St NE
Fridley, MN 55432
Re: Window Replacement at 6810 Monroe Street NE, Fridley
Dear Mr. Ferguson:
On June 15, 1995 an inspection was conducted of the window
replacement at your address. During this inspection you were
informed that the windows which were replaced in the sleeping rooms
did not meet minimum Code requirements. Uniform Building Code
Section 1204 requires every sleeping room to have at least one
openable window for emergency escape or rescue. The window shall
have a minimum net clear openable area of 5.7 square feet; a
minimum net clear openable height of not less than 24 inches; and
a net clear openable width of not less than 20 inches.
After discussing this matter with Mr. John Palacio, Fridley's Chief
Building Official, on June 16, 1995, you agreed to bring these
windows into compliance with the State adopted Uniform Building
Code.
Your prompt attention to this matter will be appreciated. Any
questions can be addressed to myself at 572-3603.
Sincerely,
BARRY RIESCH
Building Inspector
BR/mh
CITY OF FRIDLEY INSPECTION DIV.
Effective On January 1, 1997
431 University Ave NE
Fridley, MN 55432
APPLICATION FOR POWER PLANTS
AND HEATING, COOLING, VENTILATION,
' 572-3604
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS G JQ��
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work herein
Residential
Rate
TOTAL
specified agreeing to do all work in strict accordance with the City Codes and
Fumace Shell and Duct Work, Burner -
'?o.00
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace
$ 30.00
$
representations stated in this application are true and cor/
Side Vent - Fill Out Back)
° ,1998
Gas Piping (Needed with new furnace) $10.00
r ---I
OWNER .
Gas Range
$10.00
$
BUILDING USED AS
Gas Dryer
$10.00
$
�' "�
ESTIMATED COST - PERMIT NO.�
*Air Conditioning -All Sizes
$ 25.00
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (UST ON BACK)
1% of Value of Appliance or Work $ °
Commercial/Industrial
1.25% of Value of Appliance or Work $
State Surcharge $ 50
TOTAL FEE
K -74o
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
No. of Heating Units Circle One (St
Trade Name K
BTU : HP
am) (Hot Water) arm Air)
Size No. -7,S
EDR
Fuel AJ_ f- otal Connected Load.
Burner Trade Name
ME
Size No.
EDR
HEATING COMPANY �-{s�•��• gip^�� ���� ,
Signed By Tel o. 7 0
Approved ByRough-In Date Final Date 2-
FILL OUT BACK SIIFSTACK VERIFICATION ON
REPLACEMENT FURNACE
Remarks:
_List GALTERATIONS Being Done:
A j / rZ r,,,
HEATING CO:
Signed By:
Date:
vts'l
CHE%jNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
Yes ( No
( )
r
2.
Is free from rust or deterioration
Yes (� No
( )
Yes (O/No
( }
3.
Has no foreign objects lodged within
4.
Is securely supported .
Yes (',,)/No
( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes (WNo
( )
6
Has total heating BTU's of
All other BTU's v znca
TOTAL BTU's
7.
Has a liner been provided for water heater
Yes ( ) No
No
(;J�
8.
Has combustion air been provided for water heater
Yes ( )
Remarks:
_List GALTERATIONS Being Done:
A j / rZ r,,,
HEATING CO:
Signed By:
Date:
vts'l
SUBJECT
O.
City of Fridley
753
AT THE TOP OF THE TWINS
BUILDING
PERMIT'(
RECEIPT N
1 �` COMMUNITY DEVELOPMENT DIV.
______
r v PROTECTIVE INSPECTION SEC.
1 I
NUMBER
REV
DATE
PAGE OF
APPROVED BV
= CITY HALL FRIDLEV $5432
�j 612-571-3450
910-F15
9/3/98
JOB ADDRESS
6810 Monroe Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3
3
1 Brookview Terrace
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Retzer
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Scott Construction780-4800
q()1,A18qq
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (30 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY 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 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 CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2570
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.
$74.75
Fire SC
PLAN CHECK FEE
TOT FEE
SIG ATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
NOPE L V LIDAPEVTHIS IS R URMI
BL )NSP
GATE
SIGNATURE OF OWNER) IF OWNER BUILDER) IDATEI
NEW - [.. ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: Z2 10 721c, ?i r () r S -r �% (
Legal Description:
Owner Name & Address:
Tel. #
Contractor: 1 a uz r -e -i c ,- gc x, MN LICENSE # 1 IJ 2613 ( d -2 X
Address: S Lf k�'o l t ar 51zc► w ✓ Tel. # 4��9 '790-10 crb
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA:
Length
Width Height Sq. Ft.
GARAGE AREA:
Length
Width Height Sq. Ft.
DECK AREA:
Length
Width Hgt/Ground Sq. Ft.
OTHER:
2&
, ' ) -e 4 V
Construction Type:
Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
DATE: I-3 ` jo
APPLICANT:
a Tel. #
CITY USE ONLY
Permit Fee
$
%
Fee Schedule on Reverse Side
Fire Surcharge
$%
.001 of Permit Valuation (1/10th%)
State Surcharge
$ /,
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
$
STIPULATIONS:
T- t5 rk
Building
PLUMBING
Hermit No.D%'J �J4SL�
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
lre 2 o07
DATE -MAIL ADDRESS
1YOUR
IE'
SITE ADDRESS
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY
Nps:
ADDRESS: SL CITY STATE IP� 3
OWNER/
TENANT
PHONE: ���ir_,rl Q_ '7�G)j
CONTRACTOR
NAME: rn ri o' k k j)nA c' o u i C e.
SUBMIT A COPY OF
STATE LICENSE # ' Aftb ZM_ EXP DATE
'hur -sO I uSTATOR- �IP S53 5-
YOUR STATE
ADDRESS: JQ (,_1 2'1�"ec: VId AeCrCITY I 1
LICENSE WITH
PHONE FAX
APPLICATION
PERMIT TYPE
*SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NES''' -% REPLACEMENT
DETAILED DESCRIPTION OF WORK
PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SINK/LAV DRAINS _ SHOWER WATER PIPING
_ _FLOOR
BATHTUB GAS PIPING amED ==Ews4 _ SWIMMING POOL WATER SOFTNER ($35)
_ _
CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _BACKFLOW PREV. ($15)
_
DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
_ _
_ WATER METER —OTHER
Permit Fee $ O
Number of fixtures @ $10.00 x $10.00 = $
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $
TOTAL DUE $
State Surcharge =$ .50
Total = $
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 for 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 a or k whic r es review and approval of plans.�J
) 1 PRINT NAME "' -`- DATE ✓ 1
SIGNATURE OF APPLICANT
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977 �/,�>