PRE 2010 DOCSCity of Fridley, Mian..
BUILDING PERMIT No. a15>
Date:
Ow
Builder
Address' Address
No. Strep '` Part t
Lot __ Block Addition or Sub -Division
Corner Lot Inside Lot Setback Sideyard _
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
Front Depth Height Sq. Fi. Cu. Ft.
it —_____ _ Depth Height Sq. F't. Cu. Ft.
Type of Construction ��� Est. Cos To be Completed
In consideration of the issuance to me of a permit' to construct the building described above, I agree to do
Mo
proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
A
In consideration of the payment of a fee of
permit is hereby granted to
to construct the building ort addition as described above. Thi$ 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 res pcts to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair =moving of buildings
within the city limits and this permit may be revoked! at any time upon violaatigqu of any of the provisions of said
ordinances.
Building Inspector
NOTICE:
This penult does not cover the construction, installation for wiring, p1um+in9, gas heating, sower or water. Be sure to we
the Building Inspector for separate permits for these items.
' ' w
APPLICATION FOR BUILDING PRUM
CITY OF FRIDLEY, MINNESOTA
Owner's Name ' ", a - " ;; Builder
Address - Address
LOCATION OF BUILDING
No. / ® Street A) Part of Lot ►j re �
Lot Block 1 Addition or Subdivision `N . A jk+j n
a
Corner Lot Inside Lot Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
To be used as:
DESCRIPTION OF BUILDING
Front Depth Height 3 l
Sq. Ft. 4,3 Cu. Ft.(...
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction FA A M F Estimated Cost �� 0
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 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.
,-I- P & L-,=&
DATE SIGNATURE
(A Schedule of Fee Costs can be found on the Reverse Side.)
BUIIDING PERMIT FEE SCHEDUIE
Section 2. The Inspector of Buildings shall, before issuing any pe
erection of any building or structure, or for any addition to any a
ing or structure, or for any alterations or repairs to any existing
structure, upon application therefor, require the payment by the ap
such permit of fees to the amount herein below set forth and in the
provided to -wit:
r - a
Lt for the
Sting build-
iilding or
Leant for
inner herein
2.1. For any such permit for the erection of any fire -proof building other than
a 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 $1.01+0 for each one thousand cubic feet, or fraction thereof, n such
cubical contents.
2.2. For any such permit for the erection of any fireproof garage, w ehouse,
factory or grain elevator, or for the erection of any fireproof addit on, for "
similar occupancy, to any existing building shall be at the rate of .25 for
each one thousand cubic feet, classified as "fireproof" by Section 50 of the
Minneapolis Building Code.
HOUSES
2.3. For any such permit for the erection of any non -fireproof build g 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
2.1+. For any such permit for the erection of any non -fireproof garag , warehouse,
factory or grain elevator, or for the erection of any non -fireproof a dition, for
similar occupancy, to any existing building or for each such building or addition.
Ninety Cents for each one thousand cubic feet or fraction thereof, in the cubical
contents thereof with a minimum of $1+.00.
For the purpose of computing fees for building permits the cubical co tents of any
building or addition to a uniform height throughout by multiplying thm ground area
covered from a point six (6) inches below the floor line of the basemaint, 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
rate of $3.00 f"orgeach Five Hundred Dollars ($500.00), or fraction
cost of all proposed work.
be at the
,f in the
2.6. In..no case shall the fee charged for any permit as set forth in Section 2 be
less than $1+.00.
City of Fridley, Minn.
BUILDING PERMIT
Date: May 22j, 1963
Owner: _ T. E. Janutka Builder
160 of Ave: N.E.
Address Address
Self (homeownet)
same
LOCATION OF BUILDING
No. 160 Street Pilot 'Ve. N.E. Part of Lot
La 14 _ Block 1 Addition or Sub -Division Carlson Sundt Nanor Sough Add.
Corner Lot _ Inside Lot Setback __ _ Sideyard
Sewer Elevation — _ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front — Depth Height Sq. Ft. —_ CU. Ft.
Front Depth Height Sq. Ft. Cu. Ft.—
Type of Construction Est. Costs �_ — To be Completed
I' ow I Itchen Addition
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 a& provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $I="--- 00 , permit is hereby granted to n • ? _: • JQ
M O mer to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota g location, construction, alteration, maintenance, repair and moving of buildings
within the city linnitsranthis permit may be revoked at any time upon violation of any, of the provisions of said
ordinances.
Allen Jensen Building Inspector
NOTICE
This pemN don not corer the commefw, hutalls m for whit0, phmblae, Bn hafts, sewa or waer. Be sun to as
tho Buildtes hupeeter for separate pwmhr for these hems.
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APPLICATION FOR BU-1ING PERMIT
w
CITY OF. FRID LMSOTA ,
OWNER'S NAMEI i k_ T 'A U -1 K A BUILDER L.
ADDRESS lb b f\v r W . F— ADDRESS
LOCATION OF BIMDING
No. Stteet�1 Lb A -;Par of Lot .
Lot . Block Addit.iow or Subdivision
Corner Lot Inside Lot.__)L .$et. ack Side -Yard
SEWER 1LEVATIQN FOUNDATION ELNV'ATION
Applicant attach to thi3 form, Two Certificates of, Survey of Lot -and proposed build-
ing location drAwn on these CA-ttificates.
,kilo
DESCRIPTION OF BUILDING
�" Ta ed s : ;
Front Depth Height
Sq. Ft. �1 Cu. Ft.
-�-- Z2-
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost
--To- be -Completed
The undersigned hereby makes application for a permit for the work-hereinspecified,
agreeing to do all work iii 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 bNN\k\a 11. M<' SIGMV E `Trs .A A iL � -P A
`tSchedule of Fee Costs can be found on the Reverse Side).
v
BUILDING PERMIT FEE SCHftIJLE
Section 2. the Inspector of Buildings $hali,:before isauiq any pe t for
the erection of any building or structure, of for any additiV to a y exist-
ing building or structure, or for: artyateratt'os,or'.:repatYs to any existing
.building or structure, upon applicatfba %4erefor,,�egUire the paymok by the
applicant for such permit of fees -tb -.the amount *herein.. below set •fo th.-acrd
in the manner herein provided to-wtt:
For any ouch permit for the oreq.tiori-of" any fireO"ob rqof utlAijg,other
Aron a garagep. warehouse, factory or. gV#in' *A•eV4tVr4 •W fir. the er td�n of
any fire -proof addition, for. a10lar"bi .Up ncy, to a$,y axis-6igg but
shall be at the rate of $1.40 for sacb.:•oue thouaend avbie feet, or• r,iroa
..:thereof, in such cubical coatgnts.•
2.2. For any such permit..fox..:.she erection of any fire"rproof gh.raue
Tziori or grain elevator, or pr -the arection of any fi&.PWoi
for similar .occupancy, to any. ekist mg htaildi"ag shall• •be at 41e
- fo'e•'eaeh one .thousand cubic .feet,', olassified as.a."fireproof" by -s-,
the •�Iiaueap�►ia•-Bufr C Md
HOUSES
2, 1. :For any such permit for the erection of nay Anon-Hreproof bur
than a garage, warehouse, factory or. grain elevator, or any non -fire
addixLon, for simildr octupa'hcy, to any eiistidg•building - permit
each one thousatn2I cabin, feet..
GA1tAGES
-2-4. For any such permit for the erection of any non -fireproof Sax
warehouse, factory or grain.elevator,.or for -the erection of any nom
additioil,'4or-similar occupancy, to any existing building 6r for enc
or addition ninety'cents ($0.90) for each one thousand c
or fTa�tiOn thereof, in the cubical• contents thereof with a minimum
For the purpose of computing fees for building permits, tha cubical
of any building or.addition to.a.uniform height throughoUt•'by
ground area covered.from a point six (6) inches below the door line
basement or cellar to the average -height of the upper surface or to
average height of the roof surface of the maim gable of a ditched t
2_5_• For repairs or alterations to an' existidg structttt4. W6 fee s
.at the rate of $3.00 per each Five gundred Dollars .($g0k; .4* frac
�therebf in the cost proposed work,'
i'
2.:6.` . to no case shalt the: ,
feezha�:gad;f..or--,aap-p�rcii�.,aW' aef•"fdrth
Section -2 .be les's_4ha=_$4-
HQs '
f'ireprovf~.
such
is feet
f $4, 0O..- . .
oritents-
Ying the---- .
of _she-_..�..,
he
f. .
D
Z
-.7-7-7.-' -.,.....
. Iul
SCALEm rm50' . .
AVENUE
PILOT ,,
0
Z
49th.
s.
i
AVENUE
13.
I ;,er�Ly cerli.^,: th+t ti- ob.,ve is a survcy•i+f U, .4 cJna (1) t'ar(n1C.h a�then (1V).
Bloc,,. one (1). Ji.iL:Ca'J e2aT AA+%0%i %CU:°i A'A,'1TIwl. Anoka County. 1,11noenota,
shvwia, th.: locution bf the houses on acid lOta.
As surveyed by we thia 25th tiey of Alarch 195.9 A. D.
Mani d,
ESnas.»ota it�clstratioo rw.25fiy .
SC#f-oc
City of Fridley, Minn. 11580
6431 University Ave. N. E., Minneapolis, Minn.. 55432
BUILDING PERMIT
Date: August 4, 1972
Owner: David 0 j a Builder Earnp
Address 172 Pilot Avenue N.E. Address Same
LOCATION OF BUILDING
172 Pilot Avenue N.E,
Na Street Part of Lot
Loi 15 Block 1 Addition or Sub -Division Carlson's Summit Manor South
Corner Lot Inside Lot x Setback — Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Gare Front 22 Depth 24' Height ._..__.1.Q.' Sq. Ft. __ 28 Cu. rt. a,=
Type of Construction
Front
wood frame
Depth
rAt. Cost
Height Sq. Ft.
$2,391.84 To be Completed _
Cu. Ft.
August 1, 1973
Stipulations: 6' Set back on side yard
Provide a hard surface driveway.
In 1iea of legal survey, owner shall hold city blameless for
side yatds.
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 d in compliance with all provisions of
Ordinances of the city of Fridley.
_n
1 1 A S a St�rr•harge
In consideration of the payment of a fee of $ 10.00 , permit is hereby granted to David 03 a
to construct the building or addition as described above. This permit is granted
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 liuildiags
within
n� city limits and this permit may be revoked at any time upon violation of any of the proviordinsions of said
c
or
CLARENCE BELISLE !
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sura to am
the Building inspector for separate permits for these items.
�_ 'I� , li
ii .
APPLICATION FOR RESIDENTIAL, ,ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWER' S NAME: DA u iD ®X- A A BUILDER: S &we
ADDRESS : i 7c2 F;14 A v c ke , ADDRESS: •-5: A V* e
NO:. / 11 STREET: D
64Lr (so '�
LOT: BLOCK:, ADDITION: �tcrn vz' 7 OA -A? ®/' s® a__/! -
CORNER LOT: INSIDE LOT: SETBACK: 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:
Gmea4 E_ —Front: '� a. -Depth: Height • _ f.
R P
Square Feet • s -Z Cubic Feet • �� 6
Rl�IRR,TRa
Front: Depth: Height;
Square Feet; Cubic Feet:
Type of Construction: uj oj Estimated Cost:
To Be Completed:
The undersigned hereby makes application for a permit for tide .vork 'he7ra&n
specified, agreeing to do all work in sttict accordance with the City 9f
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this applig4tim
are true and correct.
U TE: SIGNATURE:
(See Reverse Side For Additional Information)
-BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing p
erection of any building or structure, or for any addition to
building or structure, or for any alteration or repairs to any
building or structure, upon application therefore, require the
applicant for such permit of fees to the amount herein below s
the manner herein provided to -wit:
UNIFORM BUILDING CODE: Type 1, 2 & 4 - $2.15 for each one tho
feet, or fraction thereof, in such cubical contents. Type 3 &
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cub!
of any building or addition, is determined by multiplying the g;
covered from a point six (6) inches below the floor line of the
or the cellar to the average heights of the upper surface or to
height of the roof surface of the'main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee
rate of $3.00 per each five hundred dollars ($500.00) or frac
the cost of all proposed work.
In no case shall the fee charged for any permit as set forth inl
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE; Permits for construction will be issued a minimum of 24
time of application, to allow for proper review of the propose
of the construction site.
A Certified Survey of the lot, showing the location of the fa
has been constructed, will be required before proceeding with
CERTIFICATE OF OCCUPANCY
Application for a Certificate.of Occupancy shall be made ten (:
to the use or occupancy of any structure for which a building
issued; and said structure shall not be used or occupied until
of Occupancy has been issued.
lits for the
r existing
Fisting
tyment by the
forth and in
ad cubic
- $1.85 for
cal contents
-ound area
basement
the average
1 be at the
thereof in
Section 2 be
tours from the
structure and
Loup once it
framinSt
) days prior
mit has been
Certificate
a
-File No.
Exhibit A
7/1 T
- 4 -3 5 e
plat above shown indicates c-orrectly the size and location of
'the buildings on Premises herein insured; also the improvements now
,,cated on premises in question are entirely within thr: lo, 1*
ines
and the imDro?rements on adjoining premises do not renercach e
emises h-erein insured." 0 n
11 P p 1!
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Effective On January 1, 1991
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
%2
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
JOB ADDRESS —,,��
New Fixtures
$ 7.00
The undersigned hereby makes application for a permit for the work herein
Old Opening, New Fixture
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser
$ 5.00
and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin
$ 7.00
and representations stated in this application are true and correct.
Catch Basin
$ 7.00
>
/216 %
Rain Water Leader
$ 7.00
, 1991
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Owner /30_4�
Water Heater -Electric
$ 7.00
Water Heater - Gas
$10.00
Building Used As
Gas Range
Gas Dryer
$10.0000
$10.00
I
Estimated Cost y00 PERMIT NO.
Back Flow Preventer Required ( )Yes () No
/u
Type
$5.00
PLUMBING COMPANY
Reinspection Fee $30.00
SIGNED BY r TEL NOS3j ' y��%
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 0
1 % of Value of Fixture or Appliance
/Y
Approved By Rough -In Date Final Date
State Surcharge
$ .50
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00
TOTAL FEE
PLUS THE $.50 STATE SURCHARGE
I
A
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Effective On January 1, 1991
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
New Fixtures
3 $ 7.00
Old Opening, New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater -Electric
$ 7.00
Water Heater - Gas
$10.00
Gas Range
$10.00
Gas Dryer
$10.00
Back Flow Preventer Required ( )Yes
( ) No
Type
$5.00
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1 % of Value of Fixture or Appliance a
State Surcharge $ .50
JOB ADD
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 and correct.
'1991
Owner
Building Used As '4
Estimated Cost /li9`�PERMIT NO.
PLUMBING COMPANY
Approved By `" Rough -In Date Final Date �— �— ?/
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00
TOTAL FEE $ a 15� PLUS THE $.50 STATE SURCHARGE
11
SUBJECT
PnAr O.
City of Fridley
606
AT THE TOP OF THE TWINS
?
BUILDING PERMIT
i
_ COMMUNITY DEVELOPMENT DIV.
tr PROTECTIVE INSPECTION SEC.
I
NUMBER
REV
DATEPAGE
9/8/98
OF
APPROVED B
CITY HALL FRIDLEV 55432
�----ikl I'J
612-571-3450
910-F15
10B ADDRESS
172 Pilot Ave
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
15
1
Carlson's Summit Manor South
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Jim Backstrom 172 Pilot Ave 55421
366-3020
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
Superior Construction 8665 Jefferson Hwy Osseo 55369
424-9434 7231
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION C2 REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Fire damage repairs - Remove & replace kitchen floor joists, remove & replace stairs
going down.
9 CHANGE OF USE FROM TO
STIPULATIONS
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 80 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
$25, OOO.00
$12. SO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE RANTING OF A PERMIT
DOES NOT RESUME TO GIVE AUTHORITY TO V LATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISION OF ANY O HER S ATE OR LOC L AW REGULATING CON-
$349.75
Fire SC $25.00
STRUCT NOR THE P FORM NCE OF CON CTI
PLAN CHECK FEET
T7$392.25
License $5.00
S NATURE OF CON' CTOR OR AUTHORIZED AGENT IDATEI
N ROPA I
T IS Y.07 P IT
,NSP
�H4S
i
GATE
SIGNATURE OF OWNER OF OWNER BUILDER, IDATEI
NEW [ ]
ADDN [ ]
ALTER [ ]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 17),
Legal Description:
Owner Name & Address:
Contractor:
Address:
P 4 /
Effective 1/1/5
MOP
MN LICENSE #
6SS ED //ryA .55315 Tel. # 4a 5/ -,0 4Y34/
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
,/ DESCRIPTION OF IMPROVEMENT
Re/novs2-�- �C�c�. fi`�r,l.e�.✓�-
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: E d.,vy,40Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: 31 e APPLICANT: I rr.�e Tel. #
TOTAL $ ��
STIPULATIONS:
CITY USE ONLY
`� S
Permit Fee
$
/
Fee Schedule on Reverse Side
Fire Surcharge
$ `
.001 of Permit Valuation (1/10th%)
State Surcharge
$
/ S U
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$
G'
$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:
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any bui
any addition to any existing building or structure, or for any alteration or repair to
structure, upon application therefore, require the payment by the applicant for such pe.
herein below set forth and in the manner herein provided to -wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each
or fraction thereof, to and including $50,000
or structure, or for
existing building or
of fees to the amount
100 or
$574.75 for first $50,000 plus $6.25 for each addi
$1,000 or fraction thereof, to and including $100,
$887.25 for first $100,000 plus $5.00 for each aditi
$1,000 or fraction thereof, to and including $500, 0(
$2887.25 for the first $500,000 plus $4.25 for
$1,000 or fraction thereof, to and including $1,
$5012.25 for the first $1,000,000 plus $2.75 for
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width pli
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has
will be required before proceeding with the framing.
$1,000
$1,000
additional
000
additional
6 feet times $13.50.
to allow for proper
has been constructed
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective On January 1, 1998
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater —Electric
Water Heater — Gas**
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
Type
$ 7.00 ,70
$ 4.00 77Z070
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge $ .50
TOTAL FEE $ .2b -S0
JOB ADDRESS l 1",2 /,�,. l o t A v <,-
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 and correct.
Q , 1998
Owner
Building Used As
Estimated Cost L) Li v PERMIT NO.71
PLUMBING COMPANY__" `off P A v q "-ky 1�
SIGNED BY�%' TEL N0.
Approved By Rough—In Date Final Date
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 0�61t
PLUS THE $.50 STATE SURCHARGE
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES.
CITY OF FRIDLEY INSPECTION DIViSION Effective On January 11 998
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
Furnace Shell and Duct Work, Burner —
Also Replacement Fumace
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditioning — All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
JOB ADDRESS_ J 'i�2, A0d' io � 4 y Z
State Surcharge
TOTAL FEE
$ .50
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.
Burner Trade Name
BTU
ZW
Size No.
EDR
HEATING COMPANY .r10: .4 Wk 1�7 C -
Signed By Tel No. L(� ? - 2 D.? J
Approved ByJ Rough -In Date Final Date '
FILL OUT BACK SIDE F4 STACK VERIFICATION ON
REPLACEMENT FURNACE
The undersigned hereby makes application for a permit for the work herein
Rate
TOTAL
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
$ 30.00
$
representations stated in this application are true and cqr
,1998
$10.00
$
OWNER
$10.00
$
BUILDING USED AS
$10.00
$
/0.00
ESTIMATED COST S% PERMIT NO.
$ 25.00
$
DESCRIPTION OF FURNACE AND OR BURNER
$
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
$
Fuel Total Connected Load
State Surcharge
TOTAL FEE
$ .50
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.
Burner Trade Name
BTU
ZW
Size No.
EDR
HEATING COMPANY .r10: .4 Wk 1�7 C -
Signed By Tel No. L(� ? - 2 D.? J
Approved ByJ Rough -In Date Final Date '
FILL OUT BACK SIDE F4 STACK VERIFICATION ON
REPLACEMENT FURNACE
The
1.
2.
3.
4.
5.
6
7.
8.
CHIl 4NEY AND STACK VER—MCATION
ersigned hereby verifies that the existing chimney or stack:
as been carefully examined
Yes ()
No ( )
s free from rust or deterioration
Yes ()
No ( )
as no foreign objects lodged within
Yes ()
No ( )
s securely supported .
Yes ()
No ( )
Bets all current Code requirements for size
d total BTU's connected
Yes ()
No ( )
Jas total heating BTU's of
Ul other BTU's
OTAL BTU's
as a liner been provided for water heater
Yes ()
No ( )
HEAT
Signed
Date:
as combustion air been provided for water heater Yes ( ) No ( )
TERATIONS Being Done:
/V /
v L�
s C,� �u ✓,Z �, - .i2 S,f
CO:
vN C
I v
SUBJECT
City of Fridley
=21
AT THE TOP OF THE TWINS
BUILDING PERMIT
i �
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
aa%�
r E
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
L J` 612-571-3450
910-F15
4/23/99
10B ADDRESS 172 Pilot Avenue NE
1 LEGAL
LOT NO,
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
15
1
1 Carlson's Summit Manor South SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jerome Tollefson 172 Pilot Avenue
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Four Seasons Roofing & Remodeling 7930 University Ave NE, Fridley, MN 55432
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
795-9410 20138780
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION J7 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (24 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
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 80 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 ISTALLS
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
$2,056
$1.03
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•
$74.75
Fir SC $2.06
TRUCTION OR�THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOT FEE
Li n C
$82.84
SIGNATURE OF CON'RACTOR OR AUTHORIZED AGENT iDATEj
EN O VALIDA THIS I$ R P RMIT
/ ,_ 116LOCIRNSP JIF r)A1E
SGNATURE OF OWNEROF OWNER BUILDER, iDATE,
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Owner Name &Address: �' r.� r,, e �(�� t7,p,'1,34
� 4v. Tel. #.
ENSE #0?0%.3Z7XO
Tel. # Z2 S-- 9/ V
Contract,
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Effective 1/l/99
LIVING AREA: Length . Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Leng Wid`thh Hgt/Grou� 5q. Ft.
OTHER: `r- i� O d ) //z
Construction Type: Estimated Cost: $' ` Z� •
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: -Y-23-9 J- APPLICANT: 1A � �, ✓►7 j,,l a Ile r Tel. # r9 o - %,r / V
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge $ - do
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge
$
TOTAL $ d
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review R
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any buil
any addition to any existing building or structure, or for any alteration or repair to
structure, upon application therefore, require the payment by the applicant for such per.
herein below set forth and in the manner herein provided to -wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each k
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each
or fraction thereof, to and including $50,000
$574.75 for ftA,,,$50,000 plus $6.25 for each a
$1,000 or fraction thereof, to and including $1,
$887.25 for first $100,000 plus $5.00 for each
$1,000 or fraction thereof, to and including $5,
or structure, or for
existing building or
of fees to the amount
$100 or
tional $1,000
litional $1,000
litional
,000
lditional
,000
$2887.25 for the first $500,000 plus $4.25 for ch additional
$1,000 or fraction thereof, to and including $1, 00, 000
$5012.25 for the first $1,000,000 plus $2.75
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wii
approach with 6 inch depth - Driveway width plus 6 feet times $23
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it
will be required before proceeding with the framing.
each additional
lus 6 feet times $15.50.
5.
tion to allow for proper
s it has been constructed
SUBJECT
peftff
City of Fridley
2 9 3 7
AT THE TOP OF THE TWINS
BUILDING
PERMIT
IF
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
•�
SEC.
r � PROTECTIVE INSPECTION
� f
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
4/30/99
JOB ADDRESS 172 Pilot Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
15
1
I
I Carlson's Summit Manor
South SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jim Backstrom 172 Pilot Avenue NE
572-8795
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
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Garage (28 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State
Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
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 80 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
ISTALLS 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
$2,399
$1.20
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-
$74.75
Fir SC $2.40
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
T L FEE
_
$78.35
SIGNATU E FC CPN -RAC ROIL Aur ENT iOATE,
LY VALI A D THIS
c NER„i OWNER BUILDER, IDA?
�H�EP
gA1E
Irywve _.- , . � �:i'nP;1rP^G gar ::-._Y _�gu�_^k: +7 '�F y�..,'�Lk><?P: rT+ �k"AYA �i� .r:y�. $'T''. i.g'-4'. '� �Tz,:��T . .ori: r�qy. .-n-�i%1 �"frs�r
JV �
�' f+_
NEW [ ]
Effective 1/1/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: � �(o /-/- �
Legal Description:
Owner Name & Address:
Contract
Address:
Tel. # 67/2-' 67,z—L25
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
ENSE #
Tel. #
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK AREA: Length Width Hgt/Ground
OTHER: % 1 aa'\ a- 6^,—.L 5 -r-- ;2 `S 5
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: '01- Estimated Cost: $ 0�'- l l
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Fte-�6 t TFt i $ _ $
DATE: APPLICANT`
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Tel. # Co,(;1 -vim, 7;1- - $75.5
CITY USE ONLY
$ %Sl
Fee Schedule on Reverse Side
$
.001 of Permit Valuation (1/10th%)
$
$.50/$1,000 Valuation
$
$1050 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 [ ]
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any build ng or structure, or for
any addition to any existing building or structure, or for any alteration or repair to g iy existing building or
structure, upon application therefore, require the payment by the applicant for such pe t of fees to the amount
herein below set forth and in the manner herein provided to -wit:
'.TOTAL VALUE FEES . .
$1 to $500 $21 (Minimum Fee is $21 plus surcharge)
$501 to $2,000 $21 for first $500 plus $2.75 for each additional100 or
fraction thereof, to and including $2,000
$2,001 to $25,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000 I
$25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each ad jtional $1,000
or fraction thereof, to and including $50,000 II
$50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each ad(
$1,000 or fraction thereof, to and including $100
$100,001 to $500,000 $887.25 for first $100,000 plus $5.00 for each
$1,000 or fraction thereof, to and including $5
$500,001 to $1,000,000 $2887.25 for the first $500,000 plus $4.25 for eah additional
$1,000 or fraction thereof, to -and including $1,0V1000
$1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 for i h additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width p s 6 feet times $15.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.2 .
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of applica 'on to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has t has been constructed
will be required before proceeding with the framing.
SUBJECT
City of Fridley
31988
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
COMMUNITY DEVELOPMENT DIV.
I PT N
016
r PROTECTIVE INSPECTION SEC.
67 36®
E
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
7/12/01
JOB ADDRESS 172 Pilot Avenue NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
15
1
Carlson's Summit Manor South
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Jocine Dittbenner 172 Pilot Avenue NE
763-572-8795
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
B DESCRIBE WORK
Remove and replace 7' x 3' of Foundation which is settling;
core fill all new
51ock and aild rebar
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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
2
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
$19000
$ •50
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-
F e SC $1.00
STRUCTION$38.75 OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
WTL FEE
A46.25
5I ATURE OF CONTRACTOR OR AUTHORIZED AGENT tOATE,
HE PR LY VA DA THIS IS YOUR PERMIT
MATE
GNATURE OFG%NER,IF OWNER BUILDERi iWATE,
4"7 'IT --, 'S 11101,17t, i
G r6
NEW I l Effective 1/1/2001
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description: _
Owner Name & Address.,joO_/U L "TTE3£AW £A Tel. # C�� �,� S %� - ?7y'. -
T
Contractor: MN LICENSE #
Address: Tel. #
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
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
Length Width Height
Length Width Hgt/Ground
ra
Construction Type: Estimated Cost:
Sq. Ft.
Sq. Ft
o5�
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $
DATE:APPLICANT:��Sc�L�/I%N�%Z Tel. 7�
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
Call (763) 572-3604 for Permit Fees if mailing in application
$-- in -%S Fee Schedule on Reverse Side
$ /,00 1 .001 of Permit Valuation (1/10th%
$ O $.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 [ ]
$.�
STIPULATIONS: /'1i Pf1
BUILDING PERIVIIT FEE SCHEDULE
The Chief Building Official shall, 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 existhg building or structure,
upon application therefore, require the payment by the applicant for such permit of fet i to the amount herein
below set forth and in the manner herein provided to -wit:
TOTAL VALUE FEES
$1 to $500 $23.50
$501 to $2,000 $23.50 for first $500 plus $3.05 for each additional 100 or
fraction thereof, to and including $2,000
$2,001 to $25,000 $69.25 for first $2,000 plus $14.00 for each additio 1$1,000
or fraction thereof, to and including $25,000
$25,001 to $50,000 $391.25 for first $25,000 plus $10.10 for each addi+nal $1,000
or fraction thereof, to and including $50,000 11
$50,001 to $100,000 $643.75 for first $50,000 plus $7.00 for each
$1,000 or fraction thereof, to and including $1
$100,001 to $500,000 $993.75 for first $100,000 plus $5.60 for each k
$1,000 or fraction thereof, to and including $500
$500,001 to $1,000,000 $3,233.75 for the first $500,000 plus $4.75 for each
$1,000 or fraction thereof, to and including $1,000,(
$1,000,001 and up $5,608.75 for the first $1,000,000 plus $3.15 for eac 1 additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of applicati to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has en constructed will
be required before proceeding with the framing. New Houses Only II
'
SUBJECT
City of Fridley
2644
AT THE TOP OF THE TWINS
?
BUILDING PERMIT
r
:
-W
ECEIPT NO.
i -----_ , COMMUNITY DEVELOPMENT DIV.
fr
PROTECTIVE INSPECTION SEC.
j E
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
j
L 612-571-3450
910-F15
5/28/02
r
JOB ADDRESS 172 Pilot Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
15
1
Carlson's Summit Manor South SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jesse Dittbenner 172 Pilot Avenue NE 572-8795
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 JD REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reside House and replace 9 windows within existing openings
9 CHANGE 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 covering.
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. Caulk and flash all
exterior openings.
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.
SEPARATE PERMITS ARE REOUIRED 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
$3,000
$1.50
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-
$53.25
Fire SC $3.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
$8 .75
S1 ATUREOFCO 7RACTORORAUTHORIZED AGENT i0ATE-
EN OPE ALIDATED IS IS YOUR PERMIT
0e<,NSP FATE
S,GNATURE F OWNEROF OWNER BUILDER, iDATE,
r
;: .. _
�� �'`1 tic.
1
4
NEW [ ] CITY OF FRIDLEY Effective 1/1/2002
ADDN [ j 6431 University Ave NE, Fridley, MN 55432 (763) 572.3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: Rre_"
Legal Description:
Owner Name & Address: Tel. #
Contractor. SG`L MN LICENSE #
Address: 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:
Construction Type: fe � & �Dd�S • Estimated Cost: $ 3 �®
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$
DATE: - 2Sl ®0— APPLICANT:e� l 5�� kJJ L 1 1 �U ^� C� Tel. # 5-;,22—
Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-5714287 if using credit card and we will
call you for card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ '59-
$ ?
$ /.. So
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 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 [ ]
TOTAL $ e2, 75_ STIPULATIONS:
BUILDING PERNUT FEE SCHEDULE
The Chief Building Oficial shall, 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
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional$��00 or
fraction thereof, to and including $2,000 II
$69.25 for first $2,000 plus $14.00 for each
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each addid
$1,000 or fraction thereof, to and including $100,0(
$993.75 for first $100,000 plus $5.60 for each k
$1,000 or fraction thereof, to and including $500
$3,233.75 for the first $500,000 plus $4.75 for each
$1,000 or fraction thereof, to and including $1,000,(
$5,608.75 for the first $1,000,000 plus $3.15 for
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $17.
Permits for construction will be issued a minimum of 24 hours from the time of
review of the proposed structure and of the construction site.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing foundation
proceeding with the framing. New Houses Only
additional
to allow for proper
be required before
AV
Building'
BUILDING
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date AM JQ
763-502-4977 FAX
.001 times the total job valuation
Surcharge $
EFFECTIVE 1-1-09
License Surcharge $
DATE �' &
YOURE-MAIL ADDRESS C-0
SITE ADDRESS L � -
I-,
�LG3 I &2C P9
ft + 6 ft = ft x $21= $
THIS APPLICANT IS:
,OWNER ❑CONTRACTOR
Park Fee $
PROPERTY OWNER/
NAME: 7 ® 9f
Agreement necessary ( ) Non Necessary ( )
ADDRESS: J ?a N ILl I 91 CCAe CITY
STATE &��ZIPMZL
TENANT
I hereby apply for a building permit
PHONE:
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
CONTRACTOR
NAME:
SIGNATURE OF APPLICANT
STATE LICENSE # EXP DATE
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
ADDRESS: CITY
STATE ZIP
INSURANCE
PHONE FAX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDTIION ❑ GARAGEISHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
—HECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR. ❑ REMODELING
DESCRIBE WORK BEING DONE: �°��Q5Z4
—r
r r
���
SIZE OF IMPROVEMENT
uu
LENGTH ' -!_r— WIDTH HEIGHT O l S FT
ROOFING
❑ HOUSE ONLY
BASEMENT
REMODELING SUBMIT:
NUMBER OF SQUARES
❑ HOUSE & GARAGE
1.
Existing Floor Pian
GARAGES
❑ ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS_
1.
& PORCHES SUBMIT:
Site Plan/Survey showing the existing structures
[3 Aluminum
13 Trim
and Proper Prof
[3 Other
❑ Fascia
2.
Two sets of construction plans
WINDOWS
3.
Energy Calculations
IN EXISTING OPENINGS ❑Yes ONo 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 997 U. C�' EE SCHEDULE)
TOTAL JOB VALUATION $
s� a cr O v OCCUPANCY TYPE
Permit Fee $
See Back Page for Fee Schedule
Plan Review $
65% of Building Permit Fee
Fire Surcharge $
.001 times the total job valuation
Surcharge $
.0005 x Permit Valuation Minimum $.50
License Surcharge $
$5.00 (State Licensed Residential Contractors)
SAC Charge $
$2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $
ft + 6 ft = ft x $21= $
Erosion Control $
$450 Conservation Plan Review
Park Fee $
Fee Determined by Engineering
Sewer Main Charge $
Agreement necessary ( ) Non Necessary ( )
Total Dae $
Make checks pgable to: of Ep:dla Attach Sti ulratlons
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 ay work which requires review and approval of plans.
SIGNATURE OF APPLICANT
PRINT NAME)ATE 611el 40f
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK
WE