PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date: ... !Ttme.24#.159...................
Owner.......................................
N® 396'
Builder ...B .Benoo8..........................
Address.............................................
LOCATION OF BUILDING
No. ...... Street .. Monroe. St.. N!..T.4!............... Part of Lot ...............................
Lot .... A ...... Block ........3......... Addition or Sub -Division .. DXO0JW18Ti1..` 9rX=9#..3rd . Adda.
Corner Lot ............ Inside Lot ..A ........ Setback 3.5!Q! ..... Sideyard ..1 0 ..................
DESCRIPTION OF BUILDING
Tobbe�eUsed as:
..+�!!g4ni+. Q ....... Front .41%! Depth � !6M .. Height A .... �. Sq. Ft. 1054:.. Cu. Ft. 2DO25. .
.................... Front ........ Depth ........ Height ........ Sq. Ft......... Cm Ft. ........
Type of Construction ................... Est. Cost..$19# .W ..... To be Completed ...................
In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do
the proposed work in accordance with the description abo forth and in camplian with all provisions of
ordinances of the city of Fridley.
��
In consideration of the payment of a fee of $. d4:T...., 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 ions of. said
ordinances.
`:`........�/... Building Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items
City of Fridley, Minn.
BUILDING PERMIT
Date:
Owner:... _.... ......�...:..ti�,.y ...... ��._.__�.��'° . .
�_.... Builder
Address ._. ['-•.f_�._.. gydress
LOCATION O ILPPG
No...... /_i Street _. � ,�3" w....: _ , . Part o Lot ....._.....___:_.__..._..____....... .._.......__. _
tib Oil s
Lot .-............ ......... Block ....._.................._.. ........... Addition or Sub cion _ ......:... .... �.,.:... ....�J_...:;
Corner Lot .....- ............................ Inside Lot ....._...............' "� ._ aback .---. ....::_ Sideyard ...-•--
Sewer Elevation -------- --------- _.......... __......... _...... _..._............... _.................. Fo dation Elevation
DESCRIPTION OF BUILDING 41
To,Pj Used as -
-.. ...-+ ..�r-. Front rte`....90.. Depth ..... Height .��....._. Sq. Ft. Cu. Ft. 5;
.... ........ ......_... ......--------.........-- --....__.. Depth _..._.:... Height ....._.... Sq. Ft. ------............_.. Cu. Ft. _..---............ ...
Fro t ....
o
Type of Construction "'" ^a ':.... Est.st .f.: _ To be Completed ............... ...................................
-`
CAU ! 161 1
PHISVI�LAT-
ION' Oi= Al -.!Y r,.JjL.LA,:
D COVENANTS AND
lni ivy.
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. IL
-
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 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, re air and moving of buildings
within the city limits and this permit may be revoked at anyu olatfon f any of the provisions of said
ordinances. /
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these Nems.
i'
a
zj- la" �,
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name g �eal -;r-aer Builder
Address Z.&,? J7 Al &' Address
LOCATION OF BUILDING
No. Street Part of Lot
S
Lot Block. Addition or Sub.Div.
Corner Lot Inside Lot Set Back Side -Yard
SEM ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
Ae5� r- Le=-4-04rront -20 Depth�,��
Sq Ft. Cu. Ft. '` ' 11 _
Front Depth Height
Sq. Ft. Cu. Ft,
Type of Construction j;stimated Cost /,:D 6
To be completed PLO
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representa-
tions stated in this application are true and corre t.
DATE ar , SIGNATURE
(A Schedule of Fee costs can be found on the Reverse Side.)
�9,-20�/
City of Fridley, Minn.. N° 8096
BUILDING PERMIT
Date: July 1, 1965
Owner: Ruth Melander Builder E. Norberg_
Address 6862 Monroe N. E. Address 5501 Logan No.
LOCATION OF BUILDING
Na 6$62. zeet _ Monroe N. E. Part of Lot
Lot 6 _ Block 3 Addition or Sub -Division Brookview Terraces 3rd
Corner Lot _ Inside Lot Setback Sideyard
Sewer Elevation — Foundation Elevation
To be Used as:
DESCRIPTION OF BUILDING
Front Depth Height Sq. Ft. Cu. Ft
Front Depth Freight Sq. Ft. Cu. Ft
Type of Construction Est. cost —X00:00 _ To be completed
Storm Damage (Repair
In consideration of the issuance to me of a permit to const
the proposed work in accordance with the description above set
ordinanoas of the city of Fridley.
I above I agree to do
with ail provisions of
In consideration of the payment of a fee of $ 10.00 , permit is hereby granted toE - Norherg
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
wig city limitnd this permit may be revoked at any time upon violation of any of the provisions of said
Allen Jensen Building Inspector
NOTICES
M putt don net sows the eeedmd1on, hwaltalloe fey wbb& phumbins, on heating, sma m wdw. Be sun. to an
do a Ming bgwdw fm atpm to pwmHs fw than (yens.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME BUILDER
ADDRESS
ADDRESS
LOCATION OF BUILDING
- Street Part of Lot
LOTS �LOCR� ADDITION OR SUBDIVISION J 'u .
Corner Lot Inside LOT_ Setback Side -Yard,
..SEWER ELEVATI M FOUNDATION ELEVA'iIOH
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To be used as;
DESCRIPTION OF BUILDING
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
j Sq. Ft. Cu. Ft.
7_7
Type of Construction��c.Estimated Cost ice;
i
To be completed+i�, "
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.
DA a SIGNATURE �C
(Schedule of Fee Costs can be found on the Rei �"" Side).
• L�na/Plarmin9 370M�is,�si�i.�N�
- I'�rulstirveyiu� Mien/s 2/.
(4a&
sps ENGINEERING, I N C.awl mmidpa/'°
llftyimff ily -- En iaeers Surveyors
---
9 .
�cate of For== BYRNE btx5o
c+�rtsf' survey ear
I
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L
� gra �--�-�-
k
ku
V)
_ ®cuo,►Es U-riLiry
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DRkmkQE F-MWAEN'T
/bv+eby y Niis a wad repre afw of a 5wwey +}rAx &w dwies & Aw sbravkd &d
orAr lcca n Brat! bare�ldin�s, #reon, &ada l risime arrrea�_ mis , i�' , »ora,said lad, As survetJrd 6� me fl�s�-- aby
J� A.fl SUBURBAN ENGINEERING , INC.
ly
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pi
SUBJECT
ER NQ.
City of Fridley�.
x 33 76
AT THE TOP OF THE TWINS
PERMIT
t
BUILDING
ECEIPT NO.,
i
COMMUNITY DEVELOPMENT DIV:
>tr
J
1
a r PROTECTIVE INSPECTION SEC,
r
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
�•«• �� ,•1 612-560-3450
910-F15
21 0/76
JOB ADDRESS 6362 a-Ionroa Sttreet. AX.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
6
3
Broo:wiaw-,exrace SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
:. maiaadar 6862 �bnros Suet N.�,.
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
Guczaunsen Construction Co. 2054 3rd Avenues N.W.
4 ARCHITECT OR DESIGNER. MAIL ADDRESS ZIP PHONE LICENSE NO...
5 ENGINEER MAIL ADDRESS ZIP PHONE, LICENSE Na.
6 USE OF BUILDING
I-L-sidsntial
7 CLASS OF WORK
D NEW O ADDITION q ALTERATION ❑ REPAIR 0- MOVE. O REMOVE
B DESCRIBE WORK
Construct a fire'clace
4 CHANGE -OF USE FROM TO
STIPULATIONS
TYPE OF CONST:
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED•FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. -
Brick
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
I
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
. 31 R 400
.70
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.
$:':. LIC?
PLAN CHECK FEE
TOTAL FEE.
- 1 .1M9.
it -1
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
•
"- 1 IPS � �`.ry�f _�.�' %.
BLDG INSP DATE
SIGNATURE OF OWNER IIF OWNER SUILDERI IDATEI/
pi
•' .APPLICATION FOR RL•SI-DENTIAL., ALTERATION,
OR ADDITION•BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME VA A? Py- BUILDER : l �o„� ,,•� s ,J ®vu s+_ �O,
ADDRESS: f*, 8C, 2. d ra _01 ADDRESS : YT,
STREET • % 2 M carr•, o t ° f�
LOT: BLOCK: ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this fora. Two Certificates.�f Survey-of-L-ot and.proposed
building location diuwn on these Certificates.
DESCRIPTION'OF BUILDING
To Be Used As:
p 2 ront : Depth: Height:
Square Feet: Cubic -Feet:
• Front:' Depth: Height:
Square Feet; Cubic Feet:
Type of •Construction: �r :� K� . Estimated Cost: ,
T6 -Be Completed:
---0
The undersigned hereby makes applicativp-for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fiidley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations ated in this application
are true and correct.
•
DATE: ,Q o ,Z SIGNATU .
Illy
(See Reverse Side For Additional I fo on
i
r
qY G, c C, a —
g
SUBJECT
PE
City of Fridley
8
AT THE TOP OF THE TWINS
BUILDING
PERMIT
R
Ir? ' '
COMMUNITY DEVELOPMENT DIV.
33o4
r ' PROTECTIVE INSPECTION SEC
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
8/29/95
JOB ADDRESS 6862 Monroe Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
3
Brookview Terrace 3rd
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Bob Treuchel 6862 Monroe Street NE
574-9732
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 P ADDITION ❑ ALTERATION O REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
Construct a 15' x 16' Screen Porch
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
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
$3,984
$1.99
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
$87.25
Fire SC $3.98
PLAN CHECK FEE
TOTAL FEE
93.22
S Ti�✓ FCQI�R R AUTHORIZED AGENT (DATE,
WHEN PAA
RLY VALIDATED THIS IS YOUR P RMI
r
r44TE
�
SSG ATURE OF OWNER iiF OW ER BUILDER1 iDATM1
aa�.^.'�,`a:a....,., .�,�:>,.o,,;,::. ,..., , nc,<,.,. , .....,.,r:xx>;,;,;,. o::,..wo�,,,. , ...,.,.......... , .....,. , ,..........>.,.s,,.ws, .',:�,..�,:";•, .,,>,,.>:f,.,X ,..,..., , , . ,. ... ....... . . . . ..... ......... . ...... ,. ,
NEW [ ] Effective 8/1/95
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application '
Construction Address: 2— l D �! 2U 5 C 7-/t �'�CG %W�/ �S`f 2
Legal Description:
Owner Name & Address: j olS 7- Z cU (-iq L ,4I1A E Tel. #
Contractor: %\JUNV; MN LICENSE #
,97y-9732
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width jgt/Ground Sq. Ft.
OTHER: sckatN Pito ) , y 1(0 �r
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimated Cost: $
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: F . + Ft = Ft x $ _ $
DATE: APPLICANT: Tel. # 9-7f--7732
_
STIPULATIONS:
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$�
.001 of Permit Valuation (1/10th%)
State Surcharge
$T` ; -y
$.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
$ 6 2'
STIPULATIONS:
CITY OF FRIDLEY INSPECTION DIVISION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential Rate TOTAL
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace $ 30.00 $ -0. CD
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace) $10.00 $
Gas Range $10.00 $
Gas Dryer $10.00 $
*Air Conditioning - All Sizes $ 25.00 $ o 6b
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $
Commercial/industrial
1.255/6 of Value of Appliance or Work $
Effective On January 1, 1998
JOB ADDRESS -& MDO M I? S+, 06.
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes and
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true ano correct.
,1998
OWNER_
BUILDING USED AS WP- j DQ
ESTIMATED COST qi 1!% •60 PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units I Circle One (St.
Trade Name
BTU ') HP
am) (Hot Water(Warm
Size No. (,( Gp W-6 -7
_ EDR
Fuel Total Connected Load
State Surcharge $ .50 Burner Trade Name
TOTAL FEE $ � .15®
MINIMUM FEE FOR ANY HEATING COOLINGNENTILATION
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.
[
kLkukd
Size No.
HP EDR
c.L )1i_mft aa-L4/01h" t+/8'
HEATING COMPANY R[pT '
Signed By
Approved By -
Rough -In Date.
FILL OUT BACK SIDE FOR STA VERIFICATION ON
REPLACEMENT FURNACE
Tel No.
Final Date
3 a�lo�
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
�zy2'�
CHDJ NEY AND STACK VERIFICATION
The
undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
Yes 011"No
( )
2.
Is free from rust or deterioration
Yes (ONo
( )
3.
Has no foreign objects lodged within
Yes (4/11*'No
( )
4.
Is securely supported
Yes (/o
( )
5.
Meets all current Code requirements for size
and total. BTU's connected
Yes (/No
( )
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7.
Has a liner been provided for water heater
Yes () No
( )
8.
Has combustion air been provided for water heater
Yes (--)INo
( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
�zy2'�
It
March 30, 2006
TO WHOM IT MAY CONCERN:
UCHEL GIVE�DAN AND DAWN LOCKEDR ACING S RFAC, ST
I SUSAN TRE .
FRIDLEY, MN 55432 PERMISSION OTT SEMEN AND COME TO THE
TO EXTEN•ppASS THE TARE
PROPERTY LINE ON THE NORTH SIDE OF THEIR HOME-
I
_
r1oni.\,rnyU1r1lulay IU.INJ1141Lh.! rawo, IJC. VQl6.Wc.7/Lwll 1&941t..A7I rvi
Building
Permit Fee
BUILDING
x''7,0? S See Back Page for Fee Schedule
Permit lro
Inspections e
65% of Building Permit Fee
RESIDENTIAL APPLICATION
$
Received By:
763-572-3604
$
CITY OF
License Surcharge
!S&JI al 1 2W8
DATE_
YOUR E-MAIL ADDRESS
.t/1
SITE ADDRESS
Curb Cut Escrow
$
THIS APPLICANT IS:
0 OWNER CONTRACTOR
$
PROPERTY OWNER/
NAME:—
$
ADDRESS: 61 6z CITYy,Q�ly/a✓
sTATEfZVZII' g�
TENANT
Agreement necessary ( ) Non Necessary ( )
PHONE: 7&.5 - .5711-9 y3z
$
CONTRACTOR
NAME: Li�Lo/ ,�-•-
STATE LICENSE # 4014Z/.'99 EXP DATE 3/3(�Zcni
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: '7808 //3;12 ,fie CITY C/%�a/
STATEh.�ZII= SS3I(e
VATH APPLICATION
PHOS 7 °3 - 7f?- - d% -7 FAX
PROPERTY TYPE
0 SINGLE FAMILY/NEW CONSTRUCTION SIZE
0 TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
0 ADDITION 0 GARAGEISHED 0 WINDOWS
O BASEMENT FINISH ROOF ❑ DRAIN TILE
0 DECK 0 SIDING 0 OTHER
❑ SWIMMING POOL
TYPE OF WORE:
❑NEW 0 ADDITION
D MAIlVTENANCEIREPAIR 0 REMODELING
DESCRIBE WORK BEING DONE: e 2vGF
SIZE OF IMPROVENIENT LENGTH WIDTH
HEIGHT Sq. Ft
ROOFING
0 HOUSE ONLY
NUMBER OF SQUARES �_ � HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGES
AATTACBM GARAGE
1.
2.
ng Flow Plan
E Proposed P
plan
floorplan
PROPOSED SIZE:
0 DETACHED GARAGE
3.
Lof sLvctnral members to be used
List
List
PROPOSED HEIGHT:
SIDING
FOP, NEW CONSTRUCTION INCLUDING DECKS,
0 Vinyl
OSoffit
ADDITIONS
& PORCHES SUBMIT -
0 Aluminnm
0 Trim
1.
Site Plsn/Surny showing the existing slructnres
C3 Other
O Fascia
and proposed Project
2.
Two sets of construction pleas
WIPJDOVVS
3.!'
Ca�ttons
IN EXISTING OPENINGS Yes ONO LOCATION OF WINDOWS
O
OR FORNEW 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 L"uR AND Iv xjLExrAr.a:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ zyb ` v OCCUPANCY TYPE
Permit Fee
$
x''7,0? S See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
9 -43 .001 times the total job valuation
Surcharge
$
l ! f .0005 x Permit Valuation Minimum $.50
License Surcharge
$ S' , ®� $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1675 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21 = k-
-Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
1,n , �- Make cheeks yable to: CitvofFri4LeZ Attach Sti relations
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 all workwhichrequires . evie and approval of plans.
SIGNATURE OF APPLICANT � PRINTNAME �o f! DATE �� D�
Building
BUILDING
Permit No::' 1-0l 73
Inspections
RESIDENTIAL APPLICATION Received By:
763-572-3604
CITY OF FRIDLEY Date '9: OCT 6 9 200
763-502-4977 FAX
License Surcharge
$
EFFECTIVE 8-19-09
$
DATE I U` o Q— ` 0
q YOUR E-MAIL ADDRESS
Erosion Control
SITE ADDRESS to Q�hZ
M D tJ RD 4� !�> I SJ
$
THIS APPLICANT IS:
ER ❑CONTRACTOR
51OWN
Total Due
PROPERTY OWNER/
NAME: V (_ L'LC
TENANT
_
ADDRESS: Z M 0 M P-0 E S[•
aTy RIVD LE'� p
STATE IP—�z�
rr /
y
PHONE: 7 �I a — 51 — 1-2 3-2—
CONTRACTOR
CONTRACTOR
NAME:
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE #
EXP DATE
AND CERTIFICATE OF
ADDRESS:
CITY STATE ZIP
INSURANCE
PHONE
FAX
PROPERTY TYPE
IX SINGLE FAMILY O
SIZE %(,j W
❑ TWO FAMILY/NEW CONSTRUCTION
STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED
❑ WINDOWS
❑ BASEMENT FINISH❑ R F
❑ DRAIN TILE
❑ DECK DING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCEIREPAIR R'REMODELING
, A , y r
DESCRIBE WORK BEING DONE: 6I *D� � � Q,� � A C I N & 5 HA
K.G�
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
11 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:
3IDA�TG
FOR NEW CONSTRUCTION INCLUDING DECKS,
amyl
❑Soffit
ADDITIONS & PORCHES SUBMIT:
13 Aluminum
❑Trim
I. Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
FOR WINDOWS — PROVIDE U -VALUE AND
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
�(USI rl 11997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ °° �J� OCCUPANCY TYPE
Permit Fee
$ -15
Plan Review
$
Fire Surcharge
$?z
Surcharge
$ l e a
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)
$2000 per SAC Unit (Plans to MWCC for determination)
-ft +6 ft= ftx$22=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of I wo/r►k� wrequiyes rffview and approval of plans. L
SIGNATURE OF APPLICANT / P���I PRINT NAME !jU$W JR&C4&L DATE�I D