PRE 2010 DOCSCity of Fridley, Mmm
CA F UILD G
No. Street P Lo
Lot Block Addition or Sub-Divisi d
Corner Lot Inside Lot Setback jfi Sideyard _
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
Toa Vsed
;/
kr
Front3 Depth Height Sq. Fi. Cu. Ft
i Fro t Depth Height �-- Sq. Ft. Cu. Ft.
Type of Construction Co 9==—To be Completed
In consideration of the issuance to me of a permit to constructFffing des above, I agree to do
the proposed work in accordance with the description above set fon m li ce th provisions of
ordinances of the city of Fridley. P
��
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. repair and moving of buildings
within the city limits and this permit may be revoked at any upon Ola on of any of the provisions of said
ordinances.) d
Building Inspector
NOTICE:
'this perndt does not cover the construction, Wt 9ndon for whine, phnnhing, ems homing, Bower or water. Be sure to see
the Building hupecter for separate penaHs for these hems.
City 1Fridley.)Minn. s 8132
BURDING Lw 30)0
Date:
July 7, 1965
Owner: Gerald De Shaw Builder Chas. E. Johanson.
Adder 530 Rice Creek Blvd. Adder 160 Hartman circle
LOCATION OF BUILDING
No.5__.30 street Ri6e Creek Blvd, Part of Lot
Lot 7Block Addition or Sub.Division HoUday Hila.$
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. Cost l 100.00 To be Completed
Storm damage repair
In consideration of the issuance to me of a permit to construct the build
the proposed work in accordance with the description above set fob fid in
ordinanoes of the city of Fridley.
I agree to do
provisions of
In consideration of the payment of a fee of permit is hereby ted to Chas. E. Johanson
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 paw thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, consiruction, alteration, maintenance, repair and moving of buildings
of
within the city limits and this permit may be revoked at any time upon violation of any of the provisions said
ordinances.
Allen Jensen Biding Inspector
NOTICE
This pemW don not cover the asmtmd1w, haftWen for wf&lh plumbing, on hemtlu& sewer or water. Be acre to sen
the Building Mqm for for sepwa% pormtts for these
t
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAM'% BUILDER J -�
ADDRESS_ �, �� ADDRESS A
LOCATION OF BUILDING
Nd. Str6et Part of Lot
LOTs�BLOCK / ADDITION OR SUBDIVISION_.,
Corner Lot-,, Tnside.LOT • Setback Side -Yard
SEWER ELEVATION __-�-_ FOUNDATIOM ELEVATION.
Applicant attach to this form Two Certificates of SurVey of Lot and proposed
building location: drawn on these Certif4 ates.
DESCRIPTION OF BUILDING
To be used as:
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Oas1struction Estimated Cost
To be completed
The undersigned hereby makes,application for a permit for the work herein specified,
agreeing to do -all work in strict accordance with the City of Fridley Ordinances
and rulings of the Department of Buildings., and .hereby declares .that all the facts
and representations stated in this application arentrue•and correct.
DATE
(Schedule of Fee Costs can be found on the Reverse Si46.
BUILDING PERMIT FEE SCHEDULE
SES 2. The Inspector of Buildings shall, before issuing any permit for the
erection of any building or structure, or for any addition to any existing build-
ing or structure, or for any alterations or repairs 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;
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 $1.40 for each one thousand cubic feet, or fraction
thereof, in such cubical contents.
2.2. For any such permit for the erection of any fire -proof garage,
Warehouse, factory or grain elevator, or for the erection of any fire -proof
addition, for similar occupancy, to any existing building shall be at the rate
of $1.25 for each one thousand cubic feet, classified as "fireproof" by
Section 502 of the Minneapolis Building Code.
HOUSES
2„.3. For any such permit for the erection of any non -fireproof building,
other than a garage, warehouse, factory or grain elevator, or any non -fireproof
addition, for similar occupancy, to any existing building - permit $1.00 for each
one thousand cubic feet.
GARAGES
2.4. For any such permit for the erection.of any non-fireproof.garage,
wararouse, factory or grain elevator, or for the erection of any non -fireproof
addition, for similar occupancy, to any existing building or for each such
building or addition - ninety cents ($0.90) for each one thousand cubic feet
or fraction thereof, in the cubical contents thereof with the minimum of $4.00.
For the purpose of computing fees for building permits, the cubical contents
of any building or addition to a uniform height throughout by multiplying the
ground area covered from a point six (6) inches below the floor line of the
basement or cellar to the average height of the upper surface or to the average
height of the roof surface of the main gable of a pitched roof.
2.5. For repairs or alterations to an existing structure, the fee shall
be at the rate of $3.00 per each Five Hundred Dollars ($500.00) or fraction
thereof in the cost of all proposed work.
2.6. in no case shall the fee charged for any permit as set forth in
Section 2 be less than $4.00.
SUBJECT
PERMIT NO.
City of Fridley
AT THE TOP OF THE TWINS
PERMIT
(1::0:0�3
BUILDING
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
�����
1 _�
/---I CITY HALL FRIDLEY 55432
NUMBER
PAGE OF
APPROVED BY
612-560-3450910-F156-9-75
=REVIDATE
JOB ADDRESS
530 RICE CREEK BOULEVARD, FRIDLEY, MINNESOTA
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
7
1 1
1 HOLIDAY HILLS SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
GERALD DESHAW, 530 RICE CREEK BOULEVARD
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
CUSTOM POOLS 701 E, EXCELSIOR -
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
SWIMMING POOL
7 CLASS OF WORK
❑X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
INSTALL SWIMMING POOL 18 x 36, Alum with vinyl
9 CHANGE OF USE FROM TO
STIPULATIONS
E�ERATE P RiviiTs REQUIRED FOR WIRINGI manvv
HEATING, PLUMBING AND SIGNS. Before digging c81l l0ceiGAS
Ede
TELEPHONE - ELECIg
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
Alum W vlri
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
R-1
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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.
$7,000
$3.50
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 OT ER STATE OR LOCAL LAW REGULATING CON-
$42.00
STRUCTION ORT P FORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
11
1 $45.50
SIG TW.RITO.ORAHORI AGENT (DATE)
kjWHEN PROPERLY VALI ATED THIS IS YOUR PERMIT
JUNE 9, 1975
BLDG. INSP _ DATE,
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
rt
,
1,-7��� 7��rac�
r A� �.;�t�'�dl�..i.+�•a�`i•�i r':P.��l+`t ; s'e�'ii ��`i4 6-
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-
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•APPLICATION FOR RESIDENTIAL., ALTERATION,
OR ADDITION.BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME: BUILDER: ! 5
ADDRESS: / ADDRESS
NO:. STREET:
s
LOT: BLOCK:. / ADDITION:
CORNER LOT. INSIDE LOT: SETBACK: "D ARD:
Applicant attach „o this form Two Certificates of Suryey.of Lot and -proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As: �3
Front: Depth: Height:
Square Feet: Cubic.Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: Estimated Cost:
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all'work in sttict 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
IGNATURE:
(See Reverse Side For Additional Information.)'
BUILDING PERMIT FEE SCHEDULE
SECTION.2. The Inspector of Buildings 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 repairs 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:
UNIFORM BUILDING CODE: Type 1, 2 & 4 - $2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3 & 5 - $1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by*multiplying• the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the averages
height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof.in
the cost of all proposed work. '
In no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
p
NOTE: Permits for construction will be issued.a minimum of 24 hours from the
time of application, to allow for proper review of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been cons.tructed, will be required before proceeding with the framing.
CERTIFICATE OF -OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which.a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
rr �= •f' �` � r_�
3Alidam}
- -V
r�AAVV/,7f/,
6A
June 10, 1975
0
� Custom Pools
0
701 E. Excelsior Avenue
`�'•, Hopkins, Minnesota 55343
N
r
Re: Swimming Pool at 530 Rice Creek Boulevard
M Gentlemen:
Ln
Q This letter is to reiterate my conversation with Mr. Tim
O
Hannan of Custom Pools on June 9, 1975 and to make clear
W this department's requirements for the swimming pool construction
w
z at the above address:
z
1. As discussed, two (2) skimmers approved by the National
W
Sanitation Foundation will be provided.
-' 2. As discussed, four (4) inlets of approved design for
fresh and/or repurified water will be provided.
"- 3. As discussed, a main drain of approved construction
® will be provided.
Q4. The filter and pump shall be approved by the N.S.F.
w and be of sufficient capacity to provide a minimum
X turnover of at least two (2) times in 24 hours.
This department recommends a turnover rate of 6-8
O
z hours.
w 5. A deck, a minimum of 3 feet wide and sloped away from
2z the pool must be provided around the entire
perimeter
L, of the pool.
Q 6. The diving area will be acceptable provided there is no
overhead obstruction.
7. A fence or other suitable barrier, a minimum of four (4)
w feet high, that affords no external hand or foot holds
> and which is impenetrable by toddlers, must be provided
around the entire perimeter of the pool. All gates and
other accesses shall be equipped with self-closing and
latching devices which are capable of being locked.
8. An automatic chlorinator should be provided with a
[� suitable test kit.
H 9. All electrical and plumbing installations shall be
LU inspected and approved by the City Inspection Department.
V 10. All electrical lines must be 10-20 feet or more away
U from the pool surface.
L)
11. The pool fill spout must be air gapped or protected by
a vacuum breaker.
SWIMMING POOL
530 RICE CREEK BOULEVARD
I �f - 7
7Z
12. Suitable safety equipment to include but not limited
to a ring buoy and rope that is 121� times the pool
diameter, shepards crook pole, must be provided and
VA maintained with the pool at all times.
Furthermore, these and any other requirements must meet the
provisions of the Fridley City Code, Section 115, Swimming Pools.
The building permit is approved contingent on final inspections
and approval by the City.
PAGE 2
If any questions or problems arise from this letter, please
feel free to contact me at 571-3450, ext. 41.
Sincerely,
v
STEVEN J. OLSON
Environmental Officer
SJO/cs
cc: Mr. Gerald Deshaw
530 Rice Creek Boulevard
Fridley, Minnesota 55432
„(✓ W �'' f
/
�/7
01
SUBJECT
PER
-City of Fridley
140.6
AT THE TOP OF THE TWINS
PERM
BUILDING
s
R CEIPT NO.
Z
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 . �
i___- ��'���,•� CITY HALL FRIDLEY -55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L J\ 612-560-3450
910-F15
5/9/77
JOB ADDRESS 530 Rice Creek Boulevard N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
7
1
Holiday Hills
SHEET
2 PROPERTY OWNER MAILADDRESS ZIP
PHONE
Gerald Deshaw 530 Rice Creek Boulevard N.E.
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
Chas. E. Johanson Inc. 424 Rice Creek Boulevard, Fridley 571-8021
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP
PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
99xxx Construct a 15' x 14110" Screen Porch
9 CHANGE QF USE FROM TO
STIPULATIONS
Area cannot be heated unless it meets the energy calculations.
�EPERATE PERMITS REQUIRED FOR WIR1MG
HEATING, PLUMBING AND SIGNS.
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
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
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.
2500.00
$1.25
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STA OR LOCAL LAW REGULATING CON-
$15.00
STRUCTIO O THE PERFORMA OF CONSTRUCTION.
/ %
'' �/
PLAN CHECK FEE
TOTAL FEE
$16.25
SIGNATURE OF CONTRACT0,6R AUTHORIZED AGENT (DATE)'^-
WHEN PROPERLY VALIDATED
THIS IS YOUR PERMIT-
BLDG. INSP
DAT
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
01
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER: A" -Z1, ��J BUILDER: G
Address: `
s-�� ri,ee a e� Address:
Tel. No.:-r�7 / ® 2-/
No.: 6-.1 0
LOT: '7
CORNER LOT:
Street: e �.
BLOCK: / ADDITION:
INSIDE LOT: SETBACK: SIDEYARDS:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
U
DESCRIPTION OF BUILDING
To Be Used As:
S� Front: % Depth: o Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet:
Cubic Feet:
Type of Construction: fc_- Estimated Cost: $ 0 U
To Be Completed: Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
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. See reverse side for additional 'nformation.
DATE: / ,-- SIGNATURE:
Stipulations:
allm d- IK 0c)
1. ?,."
fAi-C CAJCfjc I-
3 3 cit~ 1~
{ r ON
i /' f . ��•r
sz
G7� 7
/ here& crrli�y that this is a frac aid c orrrcf rnprrsenfa�ion J),j5trwy.el%. f�,vndveyes e�' a a6e,rr �d l�md, mxl
oFffx lacgfmn a�'ol/ bwld�n�r s, tlzreo rr, and ai/ ris�bli �rriarxl�men3s , i�'any. {mn a• arrsoid load. As 5wveyed if nv { �„
SUBURBAN ENGINEERING, INC_
CITY OF FRIDLEY
Effective Aug. 1, 1981
APPLICATION FOR POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
AIR
CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
RESIDEKTIAL JRATE
TOTAL
Job Address
Furnace Shell and k,
Burner $ 20.00
$ %d, � 0
Department Buildings, 6431 University Ave. N.E., Fridley, MN 55432
dl
City of Fridley
Gas Piping �u $ 10.00
(piping need with near Hake)
$
Tel. #571-3450
Gas Range !/ $ 10.00
$
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
Gas Dryer $ 10.00
$
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
Air Conditioning (all sizes) $ 10.00
$14 :
Fridley, Minn. % — f / 19�
All Others/Repairs and Alterations
OWNER
1% of Value of Appliance or Work
$
RIND Oi UILDING
COMMERCIAL/INDUSTRIAL
USED AS
1% of Value of Appliance or Work
$
TO BE COMPLETED ABOUT
ESTIMATED COST
State Surcharge
$ .50
) /
O(G o ,7
OLD NEW BUILDING PERM!IT NO. PERMIT NO.
TOTAL FEE
$
® -�
Reinspection Fee ($15.00)
$L
DESCRIPTION OF FURNACE/BURNER
Rough Insp.
BEATING or POWER PLANTS, Steam, Hot water, . Air
Date
_arm
r
Trade Name > / , C* L�6 L^ Size No.
Final Insp.
Date
Capacity Sq. Ft. EDR BTU HP
Approval for Permit
Total Connected load 42 t f. Kind of Fuel��---
/y
��'�o�(�
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00
Company
PLUS $.50 STATE SURCHARGE
Signed By
Attach stack verification form with.replacement furnace permits
Tel. No. _� + 3 7 — of
.1 /
SUBJECT
City ®f Fridley
27791"
AT THE TOP OF THE TWINS
BUILDING E R M I T
RECEIPT NO.
T COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
��
1 i
NUMBERDATE
REV
PAGE OF
APPROVED BY
= CITY HALL FRIDLEY 55432
612-571-3450
910-F15
9/15/98
JOB ADDRESS 530 Rice Creek Blvd
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
7
1
1 NmtAft Holiday Hills
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Gerald DeShaw
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Maverick Construction 11227 River Rd NE Hanover 55341
498-7401
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 5d REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house & garage (26SQ) 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
$2'228.00
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-
$74.75
Fire SC $2.23
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOT FEE
Licens SC $5 0
$83.09
S NATUR FCONTRACTORORAUTMORIZEDAGENT IDAT 1
N P OP VALIDA
THIS IS UR E IT
-
1 J
SIGNATURE OF OWNER 0F OWNER BUILDERI IDATEI
BLD INSP
MATE
.1 /
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: _::: A:��
Legal Description:
Owner Name & Address: Tel. #
Contractor:1� d�c��C.L-'� ��i5 MN LICENSE #
Address: Z�� 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: n III g at
Construction Type: �k� Estimated Cost: $ . z7II
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
$--Yiw
05--
f_
$
$
Park Fee $
Sewer Main Charge $
TOTAL
. STIPULATIONS:
$ 3> 07
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 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 [ ]
1 0
Engineering
WATER AND SEWER
Permit No.: "o
763-572-3552
PERMIT APPLICATION
Received By:
763-571-1287 fax
CITY OF FRIDLEY
EFFECTIVE 1/1/2010
Date Rec'd:
//
APPLICATION DATE: S %/L Ip YOUR E-MAIL/FAX: _
THIS APPLICANT IS: ❑ OWNER `RCONTRACTOR
JOB ADDRESS: ! �: 3D 12 " r- Cv e.. e 4
NEW CONSTRUCTION PERMIT# (IF APPLICABLE):
PROPERTY
NAME: S IS, -k4 -'J
OWNER/
TENANT
ADDRESS:_ 5-30 (Z,er IC -11C ZL,-) CITY � � STATE ZIP
PHONE: (g -
CONTRACTOR
NAME:—G e4 -11.e. s L -J 4k +t -re- . 01--C)
SUBMIT A COPY OF
YOUR STATE
I<3 t 3 ti i , 'tea S( GiO�
ADDRESS: CITYyVlrr 1x c :� lz,3 STATE ZIP �S
LICENSE WITH
PHONE CELLPHONE: (P 1 L - 9z ,l" -
APPLICATION
STATE LIC # STATE BOND: EXP DATE:
1. Narrative/written descri tion:
2. Please attach sketch showing curb line, utility line, building, etc. with distances on back page.
3. Stipulations:
PERMIT TYPE
❑. SEWER CONNECTION PERMIT $50
❑ CONNECTION PERMIT $50
,WATER
C�" WATER LINE REPAIR $40
❑ SEWER LINE REPAIR $40.
❑ ADD STATE SURCHARGE $.50
❑ SAC CHARGE _@ $2100 =
TOTAL $
OTHER CHARGES (IF APPLICABLE) PAY TO UTILITY BILLING
NEW WATER METER COST — SEE UTILITY BILLING
SPECIAL ASSESSMENTS — SEE FINANCE
WATER TAP — SEE ENGINEERING
NOTE: WATER METER REPAIR, INSP OR SHUT-OFF / EVENINGS, WEEKENDS & HOLIDAYS $125/HOUR-BILLED
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a water or sewer (new connection or repair) 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. I understand this is not a permit but
only an application for a permit andworkis not to start without a permit.
SIGNATURE OF APPLICANT U�2�1PRINT
NAME:
APPROVED BY: / ° DATE:
COPY GIVEN TO; UTILITY BILLING (only if new meter) ❑ PUBLIC WORKS ❑ ENGINEERING
City of Fridley
Engineering Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3552
FAX: 763-571-1287
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