PRE 2010 DOCSCity ®f Fridley,
Address - - U Address
LCATI N 0411t
ING
No� Street art of Lot
Lot __ Block Addition or Sub -Division
Corner Lot _ Inside Lot _ _ Se Setback _ Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
TylSOMas:
LAW 41:0A Front Depth Height Sq. Ft. cu. Ft
Fro Depth Height Sq. Ft Cu. Ft
Type of ConstructionFst a 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.
In consideration of the payment of a fee of YJ
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 tie u�, viol-ati�i of any of the provisions of said
ordinances. f pfd ,f9 .�'
Building Inspector
NOTICE
M poratt does not cover the construction, dnstalWon for wiring, phrmbing, gas heatheg, sewer or water. Be sure to see
the Building hupeetor for separate psrnft for those hams.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER ° S NAME 2Z 0 ��! S C1 d9 BUILDER S �'d yl='
ADDRESS _/-V2 5- <,C-' G&9,_A DDRESS
LOCATION OF BUILDING
No. Street�(����' Part of Lot`
Lot Block Addition or Subdividion__X t/,0 7-
e
Corner Lot Inside Lot Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as:
Front Depth 2 2 / Height
Sq. Ft. Iz .9-Z Cu. Ft. % ! 3 ze,
Front Depth Height
Sq. Ft. Cu. Ft.
ay
Type of Construction_ Al - Estimated Cost 3 15�1 0 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 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 /'� �•- _RtGNATi1RE ��
(Schedule of Fee Costs can be found on the Reverse Side).
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- City of Fridley
SUBJECT
P
®-
134�9�
AT THE TOP OF THE TWINS
BUILDING PER
r
I L.L _ COMMUNITY DEVELOPMENT DIV.
/��
r PROTECTIVE INSPECTION SEC.
I . �
rMqBE-
REV.
DATE
13/31/76
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-560-3450
10-F15
JOB ADDRESS 1425 Rice Creek Road N.E. r
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
8
2
1 Spring Valley Addition SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Floyd Paulson 1425 Rice Creek Road N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
C & M Builders 4536 Jefferson Street N.E. Columbia Heights 560-7714
4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO.
SAME
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
residential
7 CLASS OF WORK
❑ NEWl ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
family room 25' x 14'
9 CHANGE OF USE FROM TO
STIPULATIONS
1. Provide truss design
2. Insulate Ceiling with 9" batt or
equivalent R-27.
SEP ERAXE PERMITS REQUIRED FOR IRI 01
it
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
frame
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
350
2800
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,
63,000
3.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME T GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF AN O HER STATE OR LOCAL LAW REGULATING CON-
$36.00
ST TION OR TH F RMA C OF CONSTRUCTION.
PLAN CHECK E
TOTAL FEE
$#tX;l 39.00
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
EN PROP RL VAL4t, ED THIS IS YO R PERMI`"
f AT
BLDINSP E
G.
SIGNATURE OF OWNER (IF OWNER BUILDER). (DATE)
' -APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION -BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA .
o.4aER
S NMIE AJ ti BUILDER :
ADDRESS • -t �� ��� CJ Y\-� ADDRESS:. M.
NO STREET:
LOT: BLOCK: ADDITION :
COMER LOT: INSIDE LOT: SETBACK: SIDEYARD:____
Applicant attach ;:o this fora Tt,Yo Certificates. ,f.Surveg.of Lot and.groposed
building location di -Awn on these Certificates.
DESCRIPTION*OF BUILDING
To Be Used As
`nr/
�Y4 Front: Z Depth: Height:
• • Square Feet:- 5�0' Cubic . Feet :- d 0
Front:- Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: "��'✓� Estimated Cost:
T6. Be Completed: .
The undersigned hereby makes application- for a permit for the -.,York herein
specified, agreeing to do all work in strict accordance with the City of -
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
• DATE: SIGNATURE: •
(See reverse Side For Additional Information.)' rA�
9mk% (;r
` /- ®
e
SUBJECT
O.
City of Fridley
1.6 3 1
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
R I PT N
• _ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
9/8/81
JOB ADDRESS D 1425 Rice Creek Road
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
8
2
1 Spring Valley Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Marian Paulson 1425 Rice Creek Road 571-8645
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
D & D Nome Improvement 1670 Camelot Lane 574-1398
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 XJ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Vinyl siding, Aluminum window trim
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.
Vinyl & Al
im
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
3.990-00 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-
44.50
STRUC OR THE PERFORM NCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE46.49 6 49
�/q
(IN Q9
kAm R AQ AA
(N.4'j'A/
'Y
SIGNATUREOFCONTRAC OR OR AU ORI DA EN (DATE)
WHEN ROPER(Y ID11,IS YOUR PERMIT
SIGNATURE OF OWNER LIF OWNER BUILDER) (DATE)
IN P DATE
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATION FOR RESIDENTIAL BUILDING PERVITS
(New, Alterations, Additions, or Repairs)
® f f
OW14ER:
ADDRESS:
TEL NO:
BUILDER: 4me_Z;41_)xxm&naa-
ADDRESS: &Z-0 6"ee&7—Z_�
TEL NO:
Construction Location
STREET NO: I `� STREET: %I .
LOT: BLOCK: z ADDITION: P'tl;ji U C® ep �*
Corner Lot: Inside Lot: L,0000' Setback.: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIOIN OF CONSTRUCTION
Front: Depth: Height:
Square -Feet: Cubic Feet:
Front: Depth: Height:
Square -Feet: Cubic Feet:
Type of Construction: V / /?% Estimated Cost: $ 3, 1o"
00
wTWd,6*7kfn
4b Be Oorapleted: Qc ®b z
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.
DATE: 1 SIGNATURE:
Stipulations:
044a
TV
V
City of Fridley
SUBJECT
- 17 615
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
t
CEIPT N
• COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
� r
=
' I -CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
7/17/84
JOB ADDRESS 1425 Rice Creek Road N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
8
2
Spring Valley Addition SHEET
2 PROPERTY OWNER - MAILADDRESS ZIP PHONE
Marian P. Paulson 1425 Rice Creek Road N.E. 571-8645
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Bob Dierkhicin 557=6781
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
storage !
7 CLASS OF WORK
C NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
339 construct a 12' x 12' wooden shed
9 CHANGE OF USE FROM TO
STIPULATIONS
1. Shed must be 3' from side and back property lines.
2/ Must be 1UHN anchored down.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
frame
VENTILATING OR AIR CONDITIONING.
wood
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
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
$500. 00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
.50
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT F
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
15, 00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
15.50
' SIGNATURE OFC�ONCTRA�C�TOR U 12EDAGENT (DATE)
N PROPERLY VALI TED THIS IS YQ,�R PERMIT
BLDG INSP DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
RM
d
NEW City of Fridley Effective 4/1/84
ADDN. [ ] FR -1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address
Legal Description: ���"V.
�.c
Owner Name & Address: Tel. #
wn
Contractor:
Tel. #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING A EA: Length Width Height Sq. Ft.
EA: Length Width ?/ Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback _ Side Yard Setback
Type of Construction: �� � '�� - Estimated Cost: $ 601f,
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: � k Page See Bac a for Explanation
DATE: �"" �'' APPLICANT,
c el . #
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$425 per SAC Unit '
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 • FAX (612) 571-1287
CITY COUNCIL
ACTION TAKEN NOTICE
May 8, 1991
Yoava Klucsar
1337 Hillcrest Drive N.E.
Fridley, MN 55432
Dear Mr. Klucsar:
On May 6, 1991 the Fridley City Council officially approved your
request for a special use permit, SP #91-06, to allow accessory
buildings, other than the first accessory building, over 240 square
feet, on Lot 30, Block 2, Irvington Addition, and Lot 14, except
the south 390 feet, Auditor's Subdivision No. 22, generally located
at 1420 Rice Creek Road N.E., with the following stipulations:
1. One curb cut shall be maintained from Rice Creek Road.
(24';. The x shall provide a ardsurface driveway by
°j ovember 1, 1991. 0.V,
If you have any questions regarding the above action, please call
the Planning Department at 571-3450.
Sincerely,
Barbara Dacy
Community Development Director
BD/dn
Please review the above, sign the statement below and return one
copy to the City of Fridley Planning Department by May 22, 1991.
Concur with action taken
SUBJECT
City of Fridley
23430
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
IP_TN O.
�
• ______ COMMUNITY DEVELOPMENT DIV.
L I PROTECTIVE INSPECTION SEC.
r
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
"'' 612-571-3450
910415
6/2/95
JOB ADDRESS 1425 Rice Creek Road NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR,
8
2
1 Spring Valley Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Marian Paulson 1425 Rice Creek Rd NE
571-8645
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
X
8 DESCRIBE WORK
Reroof House & Garage (20 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State
Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
]
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
$1,500
@
$.75
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
$35.00
Fire SC $1.50
PLAN. CHECK FEE
TOTAL FEE
_1
$37.25
CON'�R/A�CTO R O IZEDAG NT DAT
WHEN PROPS LY VALIDATED THIS IS YOUR PERMIT
MSGREEO,FF
' 8 DG INSP
j
UATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address:
Legal Description:
!�' e!5— 6;fz---�
Effective 1/ 1/95
Owner Name& Address: /�1� /V I��I",G Say Tel. # S %1`46
Contractor: MN LICENSE #
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 H Ground Sq. Ft.
OTHER:
C'
GT
Corner Lot [ ] Inside Lot [�7Ft. Yesetback Side Yard Setbacks
Type of Construction:
_
Estimated Cost: $
Approx. Completion Date:
(Cost on Back)
Driveway C t Width Needed:
Ft. + b Ft = C-- x = $
DATE:
APPLICANT:
Tel. #
CITY USE ONLY
Permit Fee $
D
Fee Schedule on Reverse Side
Fire Surcharge $
/. U
.001 of Permit Valuation ( 1 / 10th %)
State Surcharge $
`7��
$.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 [ J Not Necessary [ ]
TOTAL $�
STIPULATIONS:
q
CITYOF
FRIDLEY
FRIDLEX MUgU
NjCC AL,�IyNTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 • FAX (612) 571-1287
Marian Paulson
1425 Rice Creek Road
Fridley, MN 55432
RE: First Notice of Noncompliance at 1425 Rice Creek Road N.E.
Dear Ms. Paulson:
The City of Fridley has established a City Code for the purpose of promoting a pleasant
and attractive suburban environment. A recent inspection of the property at 1426 Rice
Creek Road N.E. revealed that not all Code requirements are presently being met. Listed
below is an item which does not comply with the City Code:
1. Fridley City Code requires that all solid waste must be kept in secured containers
stored in the side yard, rear yard, or garage. I observed a refuse container placed
improperly at the curb. On the day of collection, refuse haulers are required to
retrieve containers from a location adjacent to the home/garage.
Your prompt attention in correcting this situation would greatly assist us in helping make
Fridley a better place to live. An inspection will be conducted on or shortly after
September 6, 1996, to determine compliance.
If you have questions or would like to discuss this violation, please contact me at 572-
3595. Thank you for your cooperation!
Sincerely,
Kurt Jensen -Schneider
Code Enforcement Officer
KJS:ls
CE -96-294
Building
Permit Fee
BUILDING
See Back Page for Fee Schedule
Permit No.: L v '
Inspections
65% of Building Permit Fee
RESIDENTIAL APPLICATION
Received By: At
763-572-3604
Surcharge
CITY OF FRIDLEY
.0005 x Permit Valuation Minimum $.50
KMAR
763-502-4977 FAX
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
EFFECTIVE 1-1-2010
ft + 6 ft = ft x $24 = $
Erosion Control
DATE
UR E-MAIL DDRES
Park Fee
$ITE ADDRESS
a �, ��r o ►,
Sewer Main Charge
THIS APPLICANT IS:
OWNER ❑CONTRACTOR
Total Due
PROPERTY OWNER/
NAME: IvarGadp
TENANT
ADDRESS:CITY
STATE IP
PHONE:
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
NSINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ROOF ❑
DRAIN TILE
❑ DECK ❑ SIDING ❑
OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ tqEW HOME CONSTRUCTION ❑ ADDITION
)fMAINTENANCEIREPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
LENGTH WIDTH
HEIGHT SQ FT
ROOFING . Q HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUA
-
SHOUSE & 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:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
[]Soffit
ADDITIONS, & PORCHES SUBMIT:
❑ 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:
S G THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 5 OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
-7 .001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $24 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
Make checks savable to: Citv of Fridlev 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 art 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 al ork which req qpNview nd approval of plans.
SIGNATURE OF APPLICAN� G' RINT NAME DATE