PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N? (:5:8j0
Date:
Owner: Builder —
Address _ — Address
LOCATIO OF BUILDING
No.; . Street '�,, t _t - Part t
Lot _ Block — Addition or Sub -Division
•-/ !
Corner Lot Inside Lot _ A --s Setback -2 --- Sideyard
Sewer Elevation _ . Foundation Elevation
DESCRIPTION OF BUILDING
To Used ,e-�
Front Depth Height. =r'` Sq. Ft cu. F ;;&GV0
ACLt Depth Height 0 Sq. Ft. Cu. Ft' ._.c
Type of onstArmetion Est. Cost ,t ...�� - 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.
6t
In consideration of the payment of a fee of -2 Ate' .�.® , 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 time upon � on of any of the provisions of said
Ordinances.
Building Inspector
NOTICE:
This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sower or water. Be sum to see
the Buildh* Inspector for separate permits for thew hoar.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Name— 'L Builder f
Address
Addtess,
LOCATION OF BUILDING
No.IV / Street Part of Lot
LotBlock_Addition or Subdivision/�/
all
Corner Lot Inside Lot Setback 5 --!) Side -Yard®
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To b used as:
Front Depth�Height LO
Sq. Ft. ® Cu. Ft. �4�
Front Depth Height y(
Sq. Ft. _Cu. Ft. _ OZ9
Type of Construction,�� Estimated Cos
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 representons stated in this application
are true and correct. /% //
(Schedule of Fee Costs can be found on the Reverse Side).
City of Fridley
Application for PiumVmg and Gas Fitting Permit
Dept. 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 ...................... g $1.50 $/--?—Ol 11
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 .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $-0�
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this applicatign are true and correct.
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old Ne ' ding Permit
�n
Business Phone
Z -
ROUGH ` �0 7s
FINAL
42 2M
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W�S,
Base
1st
2nd
3rd
4th
• Future Connection Openings
Connected with
Sewer E]
New Fixture, Old Openings
Cesspool El
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... g $1.50 $/--?—Ol 11
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 .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $-0�
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this applicatign are true and correct.
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old Ne ' ding Permit
�n
Business Phone
Z -
ROUGH ` �0 7s
FINAL
42 2M
SUBJECT
Q,
City of Fridley
314184-)
AT THE TOP OF THE TWINS
BUILDING
PERMIT(:
F
RECEIPT NO.
`� COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
6qql
CITY HALL FRIDLEY S3432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910415
10/16/00
108 ADDRESS 6401 Pierce Street NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
1
Don's Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Thomas Peterson 6401 Pierce Street NE
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Same
a 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 IR REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof House (15 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
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
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
$1,534
$.77
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.
Fire $1.53
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$57.05
SC
--
PLAN CHECK FEE
TOTA E
10 L-) ()
$X91.35
SIGNATURE OF CON'RACTOR OR AUTHORIZED AGENT IDA EI
EN PROP
VALIDATE IS IS YOUR PERMIT
+BL,NSP
/ems
DATE
�_ SIGNATURE OF OWNER,IF OWNER BUILDER, IDATEI
NEW [ l Effective 1/1/2000
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: I LC -4 KIJ s54-� 2 -
Legal
Legal Description:
Owner Name & Address: `mal&S 0 N Tel. #
Contractor: T ® K, hC1 k SO I— MN LICENSE #
Address: 6401 P 1 G–kc C �1C Tel. #
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:
k3aL)SC
Construction Type: Zk R30FI 06- TC -4- agEstimated Cost: $ (5 S C-) U O -C--5
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: APPLICANT:
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing In application
Permit Fee $ S7,05" Fee Schedule on Reverse Side
Fire Surcharge $-1,5-3 .001 of Permit Valuation (1/10th%)
State Surcharge $ , 77 $:50/$1,000 Valuation
SAC Charge $
License Surcharge $
Driveway Escrow
Erosion Control
Park Fee
Tel. #
$1100 per SAC Unit
$5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
$ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS:
$x'.55
W
Building
$
BUILDING
Plan Review
Permit No.:
Inspections
Surcharge
RESIDENTIAL APPLICATION
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 J d / ?,(0 I 0.5
YOUR E-MAIL ADDRESS 50t kG FUN i ®
I AK OO - e o �"
SITE ADDRESS ��81
�► C-%�� S) - N�:
ft + 6 ft = ft x $20 = $
THIS APPLICANT IS:
WNER ❑CONTRACTOR
$450 Conservation Plan Review
PROPERTY OWNER/
NAME: TRo- 1 =
Fee Determined by Engineering
TENANT
ADDRESS: (A Ol Pi C Tz-ce ST. .►J 1� , CITY !r��)m-c- STATE IP 5- 3 �'
Agreement necessary ( ) Non Nece9sary ( )
PHONE: 7(,3 6-71-(--097 3d5 304 8 G 2 L (c eL:�.
$ "Jgake
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
❑ S AMII Y/NEW CONSTRUCTION SIZE
0 FAMIL W CONSTRUCTION STORIES
PERMIT TYPE
'11-ADDMON ARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISHROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: 29�OQF— GP�R�e,,E
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING/� 13HOUSE ONLY
U
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGES
$f ATTACHED GARAGE
1.
Existing Floor Plan2,
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
proposed floor plan
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1.
Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
3.
Energy Calculations
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 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)
r
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 Nece9sary ( )
Total Due
$ "Jgake
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 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 work which requires review and approval of plans. (��
SIGNATURE OF APPLIC� ' -_- PRINT NAMETa 0Jk AS � [)r--TQ934A C)
M