PRE 2010 DOCSCity ®f Fridley, Mim.N° 10341
BUILDING PERMIT
Date: July 18, 1969
Owner: James Vaa Erden Builder Amber Const.
Address Address 6156 St ins on B lyd .
LOCATION OF BUILDING
No. 6Q5 0 — Street Stinson Blvd. — part of Lot
Lot _____ Block 1 Addition or Sub_Division -Amber Oaks Addn.
Corner Lot ._ Inside Lot ____ x Setback 35' Sideyard — 11' 12'
Sewer Elevation __ __ 929.49 932.4.9 Approx
Top of Footing
DESCRIPTION OF BUILDING
To be Used as:
Dwelling Front 37 Depth 48' Height 20' S4. Ft. 1294 Cu. Ft. 25,880
Garage' Front 21 Depth 24' Height 10' SqFt. 504 Cu. Ft. 5040
Type of Construction Frame Est Cost _ $27, 000.00 To be Completed
SEWER LOCATION - 134' South of Manhole
WATER LOCATION - No stub must be tapped- Watermain 8' E. of property line.
Pilaster in the basement
In consideration of the issuance to me of a permit to constri4t the building described above, I agree to do
the proposed work in accordance with the description above rth and in compliance wi potions of
ordinances of the city of Fridley. / 1! ': (' .s _
L
In consideration of the payment of a fee of $---4.7-00 00 _ _, permit is hereby granted to APr Vnn c t _ Co.
to construct the building or addition as described above. This permit is granted upon
the express conditionthat 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 reg location, construction, alteration, maintenance, repair and moving of bungs
within the city limits andildi
s permit may be revoked at any time upon violation of any of the provisions of said
NOTICE:
This permit dose not cover the construction, installation for wiring, plumbing, gas boding, sewer or water. Be sure to we
the Building. Inspector for separate permits for thus Noma.
(, APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S N '6JeA1 BUILDER" &P-�
ADDRESS. ADDRESS 611-4
LOCATION OF BUILDING
NO. STREET
LOT BLOCK�r ADDITION OR SUBDIVISION
CORNER.LOT INSIDE LOT k-'- SETBACK SIDEYARD I 12
SEWER ELEVATION TOP OF FOOTING
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:
1 Front-- Depth 7 Height
Square feet Cubic Feet
Front 1 Depth Height %
Square feet �'�� Cubic Feet
_.r
Type of Construction - Estimated Cost R �?� ^ 00
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 �� SIGNATURE
C
.{Schedule of Fee Costs can be found on the.Reverse Side
x
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 structure or building, 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 -wits
Uniform Building Codes Type 1, 2, & 4 - $1.75 for each one thousand
cubic feet, or fraction thereof, in such cubical cen.tents. Type 3 & 5 -
$1.50 for each one thousand cubic feet.
For the purpose of computing fees for buildingpermits, the cubical
contents of any building om"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 the 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.
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.
NSSSD Connection Charges based on location - Area 1 or 2.
r 0
Original Permitr rLUMBING AND GAS Fu iTING g37.3,-
mit
N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for I F�
inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit.,
DESCRIPTION OF WORK
Number, Bind and Location of Fixtures
Stories
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WATER HTR.
GAS
ELEC.
Basement
1
I
1st
2nd
3rd
4th
Connected with Sewer -Cesspool Gas Piping for openings
Permission is hereby granted Ix 4- to do the plumbing and
gas fitting in the building described the statement h eto attad4d, upon the express condition that
the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing
or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and
this permit may be revoked at any time upon the violation of any of the provisions of said ordinances.
By Order Of The Inspector Of Buildings
Roughing in Inspection Date
Inspector.
Final Inspection
Inspector.
-2 9M -6-63-V
City of Fridley 01% ,19
Owner a"A J s- r,
Location (0 8 S b
Kind of Building"
s
Used as
To be Completed .19—
Estimated Cost $ l & 36T • & - 1)
Old -New. Building Permit No. 10 '15'%1
Date
Inspector of Buildings.
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X11 '�
Ci+y ®f Fridley
Application for Plumbing and Gas FlMnq Pemdt
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures LocatiorL -
�+
IZ
3
RATE TOTAL
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WATER HTR.
GAS
ELEC.
Base
3.25
$
yyqq�
Water Heater (Up to Xpo896 BTU)
�s*"$
0®
3, d o
......
x
New Ground Run Old Bldg . ............
x
3.25
1st
/
y
l
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
x
$W&
®e
$
4,04
Additional Fixturesx
....................
�
$
0 7 5"
2nd
Gas Range to 20000 BTU ..............
x
2*0
$
a a
3rd
4th
° Future Connection Openings
New Fixture, Old Openings I
Connected With Sewer
Cesspool rl
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE TOTAL
Number Fixtures
$bft$
a a
Future Fixture Opening ................
x
%ft
$
New Fixture Old Opening ..............
x
$
Catch Basin .... .....................
x
3.25
$
yyqq�
Water Heater (Up to Xpo896 BTU)
�s*"$
0®
3, d o
......
x
New Ground Run Old Bldg . ............
x
3.25
q
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
x
$W&
®e
$
4,04
Additional Fixturesx
....................
�
$
0 7 5"
..1.9 % o 00
Gas Range to 20000 BTU ..............
x
2*0
$
a a
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $ l
City of Fridley:
The undersigned hereby .makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct.
p� Fridley, Minn ^' 19
Owner /.��
Kind of Building
Used as
To be completed about
Estimated Cost, $®� 1
Old ew . uilding Permit No-) O f1 `k _Permit No.
Signed 00—
By
Business Phone
ROUGH
FINAL /-/4-7(
CITY OF FRIKFY
APPLICATION FOR
POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
herein
AIR
CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
Codes
4.00
,
GRAVITY WARM AIR:
RATE
TOTAL
Job Address
Furnace Shell & Duct Work
$12.00
$
-v' I'llfi
Fridley, Minn. �/ 1/) _/` _ ,
* Replacement of Furnace
7.00
$
OWNER
Repairs & Alterations -up to $500.00
7.00
$
Department of Buildings
Repairs & Alterations each add. $500.00
4.00
$
City of Fridley
Tel. #571-3450
MECHANICAL WARM AIR:
Furnace Shell & Duct Work to 100,000 BTU
each add. 50,000 BTU
*Replacement of Furnace
Repairs & Alterations -up to $500.00
Repairs & Alterations each add. $500.00
STEAM OR HOT WATER SYSTEM:
Boiler & Lines up to 100,000 BTU $12.00 $
each addn. 50,000 BTU 4.00 $
Boiler only up to 100,000 BTU 7.00 $
each addn. 50,000 BTU 6.00 $
OIL BURNER- to 3 gal. per hour $10.00 $
each add. 3 gal. per hour 10.00 $
GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $
(over 199,999 BTU see Fee Schedule) $
GAS FITTING FEES:
1st 3 Fixtures x $ 3.00 $
Additional Fixtures X $ 1.00 $
Gas Range to 199,000 BTU x $10.00 $
_SIR CONDITIONING $
FAN HEATING SYSTEMS See Fee Schedule $
VEN'PILATING SYSTEMS $
ALTERATIONS & REPAIRS $
State Surcharge $ .50
TOTAL FEE $
ROUGH INSP.
Date
FINAL INSP.
APPROVAL FOR PERMIT Wfi�/g
REINSPECTION FEE
010.00)
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
*Attached stack verification form
RIND
USED AS
TO BE CC
ESTIMATE
(7D1
NEW BUILDING PERMIT NO.
PERMIT NO. Aco 1
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Total Connected Load Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
R104MO10 A WNS
Company 9// --AIR
Signed By i'1�.,�
Tel. No.
The undersigned hereby makes application for a permit for the work
herein
$12.00
$
specified agreeing to do all work in strict accordance with the City
Codes
4.00
$
and rulings of the Department of Buildings, and hereby declares that
all the
7.00
$
facts and representations stated in this application are true and correct.
7.00
4.00
$
$
-v' I'llfi
Fridley, Minn. �/ 1/) _/` _ ,
r.
19-
OWNER
Boiler & Lines up to 100,000 BTU $12.00 $
each addn. 50,000 BTU 4.00 $
Boiler only up to 100,000 BTU 7.00 $
each addn. 50,000 BTU 6.00 $
OIL BURNER- to 3 gal. per hour $10.00 $
each add. 3 gal. per hour 10.00 $
GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $
(over 199,999 BTU see Fee Schedule) $
GAS FITTING FEES:
1st 3 Fixtures x $ 3.00 $
Additional Fixtures X $ 1.00 $
Gas Range to 199,000 BTU x $10.00 $
_SIR CONDITIONING $
FAN HEATING SYSTEMS See Fee Schedule $
VEN'PILATING SYSTEMS $
ALTERATIONS & REPAIRS $
State Surcharge $ .50
TOTAL FEE $
ROUGH INSP.
Date
FINAL INSP.
APPROVAL FOR PERMIT Wfi�/g
REINSPECTION FEE
010.00)
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
*Attached stack verification form
RIND
USED AS
TO BE CC
ESTIMATE
(7D1
NEW BUILDING PERMIT NO.
PERMIT NO. Aco 1
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Total Connected Load Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
R104MO10 A WNS
Company 9// --AIR
Signed By i'1�.,�
Tel. No.
SUBJECT
PERMIT
City of Fridley
17 20 1
AT THE TOP OF THE TWINS
BUILDING PERMIT
`y ______ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
s
r
S
"1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910415
8/17/83
JOB ADDRESS 6050 Stinson Boulevard N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
4
1
Amber Oaks SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
James Van Eerden 6050 Stinson Boulevard N.E. 571-6764
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW7 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 10' x 10' Deck and a 16'*x 161 Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMIT$ REQUIRED
FOR WIRItA
WARNING HEATING. PLUMBING
AND SIGNS.
Be€ore digging call local utilities
TELEPHONE - ELECTRIC - Ga Etc.
REQUIRED BY LAW
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
$1.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2,000
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMITFEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$32.50
PLAN CHECK FEE
TOTAL FEE
$33.50
SIGNA RE OFCON�iRAC�Tp OR'A�UTHJORIZEy_DAGENT IDATEt
WHEN PROPERLY LI DATED THIS IS YOUR PERMIT
BLDG INSP - DA E
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
CITY OF FRIDLEY
APPLICATIM FOR RESIDIiMAL BUILDING PER141TS
(New, Alterations, Additions, or Repairs)
OWNER: f Va -1 �e � �� ,✓
ADDRESS: 6'050 S74,--' /3/v�. �v•
TEL NO: s;7 / G 7 G t-/
BUILDER: Se
Effective Aug. 1, 1981
a
ADDRESS: b S�-.w5�p.
TEL NO: �g-7 l i7 o `/
Construction Location
•
STREET NO: �o Sty STREET:
LOT: BLOCK: ADDITION:
Corner Lot: Inside Lot: Setback.: Sideyards: _
I
Applicant attach. to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
�e `'A ` Front:
Square Feet:
-Pe C_ 'k
Depth: /'o
Cubic Feet:
Height:
Front: /0/1 Depth: /�G Height:
Square Feet: l
Type of Construction: ®a c rr r
7b Be Completed: 5,,e7"', zo ) "'?S3
Cubic Feet:
Estimated Cost: $
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET
Mie undersigned hereby makes application for a permit for the ♦:ork 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: 81!1-7 �<93 SIGNATUIE :
Stihu'lations :
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 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:
Total Valuation Fees
$1.00 to $500.00 $10.00 (Minimum $15.00)
$501 to $2,000.00 $10.00 for the first $500 plus $1.50
for each additional $100 or fraction
thereof, to and including $2,000
$2,001 to $25,000 $32.50 for the first $2,000 plus $6.00
for each additional $1,000 or fraction
thereof, to and including $25,000
$25,001 to $50,000 $170.50 for the first $25,000 plus
$4.50 for each additional $1,000 or
fraction thereof, to and including
$50,000
$50,001 to $100,000 $283.00 for the first $50,000 plus
$3.00 for each additional $10000 or
fraction thereof, to and including
$100,000
$100,001 and up $433.00 for the first $100,000 plus
$2.50 for each additional $1,000 or
fraction thereof
Plan Check: 25 percent of building permit fee.
Driveway Depression Escrow: Concrete curb streets only.
Alternate "A": Removal and replacement of curb and gutter only -
Driveway width plus 6 feet times $13.50
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 $15.75
Verification Of Foundation
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 Certificate of Survey of the lot, showing the location of the foundation
once it has been constructed will be required before proceeding with the
framing.
elk"
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10
01
SUBJECT
City of Fridley
WER
19427
pT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
r � PROTECTIVE INSPECTION SEC.
�
CITY HALL FRIDLEY 55432
L J\
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-1715
4/29/88
JOB ADDRESS 6050 Stinson Blvd. N.E.
1 LEGAL.
LOT NO.
4
BLOCK
TRACT OR ADDITION SEE AT
DESCR
1
Amber Oaks Addition SHEETTACHED
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jim Van Erden 6050 Stinson Boulevard N.E. 571-6764
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Powers Construction Inc. 1904 Cape Cod Place, St. Paul, MN 55114 641-0111
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
Construct
dt a 10' x 10' Deck and a 14' x 16' Porch Addition and a 4' x 16' & 6' x 12'
Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plans
SEPARATE PERMITS
1 �tj1it1es RE FOR
call la�aWIRING, HEATING, PLUMBING
LUMBING AND
vq SIMS.
0011
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND.ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$2.75
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$5,500
DOES NOT PRESUME TeG1XE AUT R Y TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS `ATI HE STAT O LOCAL LAW REGULATING CON-
STRUCTIO OR TH RFO N E F CONSTRUCTION.
$56.50
PI,.AN►CHECK FEE
TOTAL FEE
"� ✓"fid ®
$14,13
$73.. 38
SIGNAT EO ONiRACTORO UTHORIZEDAGENT IDATEI
WHEN PROPERLY LIDATED THIS IS YOURfeRMIT
BLDG INSP f1AT
SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI
01
NEW [ ] City of Fridley Effective 4/1/86
ADDN. [ ] F R-1 AND R-2 i
ALTER. [ ] Building Permit Application
Constructi
Legal Desc
Owner Name
Contractor
Address
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Type of Construction: Estimated Cost: $_
Approx. Completion Date: S so o',0
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: APPLICANT: Tel.
CITY USE ONLY
Permit Fee $ _a" 60 Fee Schedule on Reverse Side
Plan Check $ 25$ of Building Permit Fee
State Surcharge $ '��`��_ $.50/$1,000 Valuation
SAC Charge $ $ 550 per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
TOTAL $ '1`3,JAgreement Necessary [ ] Not Necessary [ ]
STIPULATIONS: �,rCs�- Ss00
qo 22 q X y6 i,2d
Paco L,/4-0-2 W
O 1-4
55I
DESCRIPTION OENT
t t� 10"-txAl v
LIVING AREA:
Length Width Height
Sq.
Ft.
GARAGE AREA:
Length Width Height
Sq.
Ft.
DECK AREA:
;Length Width Hat/Ground
Sq.
Ft.
OTHER:
Corner Lot [ ]
Inside Lot [ ] Ft. Yd. Setback Side
Yard
Setback
Type of Construction: Estimated Cost: $_
Approx. Completion Date: S so o',0
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: APPLICANT: Tel.
CITY USE ONLY
Permit Fee $ _a" 60 Fee Schedule on Reverse Side
Plan Check $ 25$ of Building Permit Fee
State Surcharge $ '��`��_ $.50/$1,000 Valuation
SAC Charge $ $ 550 per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
TOTAL $ '1`3,JAgreement Necessary [ ] Not Necessary [ ]
STIPULATIONS: �,rCs�- Ss00
qo 22 q X y6 i,2d
Paco L,/4-0-2 W
O 1-4
55I
BUILDING PERMIT 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 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 Valuation
Fees
$1.00 to $500.00
$10.00 (Minimum Fee is'$15.00) /
$501.00 to $2,000.00
$10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and including
$2,000.
$2,001.00 to $25,000.00
$32.50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraction thereof, to and
including $25,000.
$25,001.00 to $50,000.00
$170.50 for the first $25,000 plus $4.50 for each
additional $1,000 or fraction thereof, to and
including $50,000.
$50,001.00 to $100,000.00
$283.00 for the first $50,000 plus $3.00 for each
additional $1,000 or fraction thereof, to and
including $100,000.
$100,001.00 and up
$133.00 for the first 41'V;"*660: plus $2.50 for each
Additional $1, 000'"di^= fr'Ciio eof .:
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus
6 feet times $13.50
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 $15.75
VERIFICATION OF FOUNDATION
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 Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
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CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
Residential
Effective On January 1, 1991
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
Rate TOTAL
o
$.2"0 $
$10.00 $
$ 10.00 $
$ 10.00 $
"Air Conditioning - All Sizes $ 10.00 $
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $
Commercial/Industrial
1 % of Value of Appliance or Work $
State Surcharge $ .50—
TOTAL FEE $
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
"Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
JOB
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 ruling of the Building Division, and hereby declares
that all the facts and representations stated in this application are
true and correct. n,ny i i �9 ", 991
.5-71-4 n' &/
OWNER
BUILDING USED AS
EST°MATED COST V/ PERMIT NO.l
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name L I Size No.
BTU HP EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
Richmond & Sons Elec., Inc. dba.
Golden Vallee Htg. & Air Cd
HEATING
Crys'2!, MhP 55429
Signed
Approved By ' Rough -In Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
a
CHIMNEY AND BTACR VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes /No ( )
2. Is free from rust or deterioration Yes (/f No ( l
3. Has no foreign objects lodged within YesNo ( )
4. Is securely supported Yes ZNo
( )
5. Meets all current Code requirements for
size and total BTU's connected Yes ) No ( )
6. Has total heating BTU's of
All other BTU's
TOTAL BTU's R. ov
Remarks
List Alterations Being Done:
HEATING COMPANY rhfllolidl Sens Elec., Inc. db:
Golden Valley Mfg. & Air Cd
Signed By 5i82IviesfQreadwav
Date
SUBJECT
IR
City ®f Fridley
2563
?AT THE TOP OF THE TWINS
BUILDING PERMIT,
r
RECEIPT NO.
• _____ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
10/27/97
JOB ADDRESS 6050 STINSON BLVD NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
4
1
Amber Oaks Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Jim VanEerden 6050 Stinson Blvd NE
571-6764
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
DeMa.rs Construction 8401 166 Cir NW, Ramsey MN 55303
441-7084 6614
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 Ck REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (27 Sq) 2nd Layer
9 CHANGE OF USE FROM TO
STIPULATIONS
Roofing can be the 2nd layer but not the 3rd.
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
MOT.
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 1 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
$1,691
$.85
WITH WHETHER SPECIFIP HEREIN OR NOT. THE GRANTING OF -A PERMIT
DOES NOT PRESUME GIVFr AUT_ ORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF AN THE ST LOCAL LAW REGULATING COW
STRUCTIO
$54.00
Fire SC $1.69
OR T ERF M CONSTRUCTION.
PLAN CHECK FEE
License SC $5.00
TOTAL FEE
$61.54
�r a
F
SIGNA URE F CTOR 'ED AGENT (0011
WHEN PROPERLYPPIDATE THIS IS YOUR PERMIT
LDG NSP
r
BATE
SIGNATURE OF OWNER IIF OWNER BU4DERI IDATEI
NEW [ � Effective 1 / 1 /97
ADDN [ ) CITY OF FRIDLEY ph
ALTER [ SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
SZ�ConstructionAddress:
Legal Description:
Owner Name & Address:
Contractor:
X- Apt, � wo Sb
a n_ Tel. # �� e� 74 %
MN LICENSE # b y
Address:_— 1 _� •-�� ao P`\ 0 � r C 4, � � Tel. # ��/ `7 C`�
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
GARAGE AREA: Length Width
DECK AREA: Length
Width
Height Sq. Ft.
Height Sq. Ft.
Hgt/Ground Sq. Ft.
OTHER:
VASIL-
Construction Type: S C V4Z_f �Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut .Width Needed: Ft. + 6 Ft = Ft x = $
DATE:
�y CITY USE ONLY
$ Fee Schedule on Reverse Side
$_ ' 1, .00.1 of Permit Valuation (1/10th%)
$.501$1,000 Valuation
$ $950 per SAC Unit
APPLICANT: _. Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
$ $5.00 (State Licensed Residential Contractors)
Park Fee $
Sewer Main Charge
TOTAL
;T[PULATIONS:
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ j Not Necessary [ )
BUILDING PERMIT FEE SCHEDULE'
The Chief Building Official shall, before issuing permits for the erection o17 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 FEES
$1 to $500 $21 (Minimum Fee is $21 plus surcharge)
$501 to $2,000 $21 for fust $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
.$2,001 to $25,000 S62.25 for first S2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$50,001 to $100,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $1()0,000
$100,001 to $500,000
.$887.25 for fust $1,00,000 plus $5.00. for each additional
$1,000*or fraction thereof, -to. and including $500;000
$500,001 to $1,000,000$2887.25
for the.first $500,000 -plus $4:25for each:additional `
$1,000 ortri tion thereof, to and including $1,000,000 `
$1,000,001 and -up
$5012.25 for the first $1;000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
` lternate "A".: Removal and replacement of curb and gutter only - Driveway width plus 6. feet tithes $13:50:
mternate "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 FOUNDA'T'ION
:.'omits for construction will be issued a minimum of 24 hours from the time of application to allow 'or proper
review of the proposed structure and of the construction site.
,t % ertificate of Survey of' the lot, showing the location of -the foundation oilce it has it has been constructed'
jv required bef)re pro:eediri «ith the fr:rllllil0-
Building MECHANICAL Permit No.:
Inspections RESIDENTIAL APPLICATION Received By:
7.63-572-3604 CITY OF FRIDLEY Date Recd:
DATE 1 YOUR E-MAIL ADDRESS
SITE ADDRESS a
THIS APPLICANT IS: O OWNER CONTRACTOR
PROPERTY NAME:
OWNER/ ADDRESS: CITY t1e, e STA1-�1ZIP
TENANT P"nWF--iU?,c=>-) 9 ` W^), W H
CONTRACTOR COMPANY NAME:
SUBMIT A COPY OF CONTACT PERSON:
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH ADDRESS: qC1 —,V) �id -E STATE b*\71P _% 14
APPLICATION PHGIdE `SCO Il�� FAX
PERMIT TYPE SINGLE FAMILY O TWO FAMILY 13 TOWNHOUSE
TYPE OF WORK: O NEW REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK
PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x .05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)' It) G i3LJ-A61 SIZE/BTU
Equipment Installed MFG: MODEL:
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
A/C $25.00 _FIREPLACE (GAS) $15.00 GAS RANGEIOVEN $10.00
AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOILER $35.00 _FURNACE $35.00 —GAS UNIT HTR $10.00
_CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 _GAS PIPING $10.00 VENTILATOR $1500
Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ Number of fixtures @ $25.00 I x $25.00 = $ 2&60
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $_____-_L0
Total = $��
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 i 'on for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in thee o work which requires review and approval of plans.IWA A c�
SIGNATURE OF AP IC PRINT NAME I`�1��
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMESIADDITIONS ZEXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEWIEXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane TGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances 1FGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a_ Per MN F.-aergy Co4e 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be u4ed for
combustion and make up air, calculations
Building
PLUMBING
PermitNO.: •
�
Inspections
RESIDENTIAL APPLICATION
Received By:
C1CITY
763-572-3604Date
OF FR.�LEY
Rec'd:
DATE I l Z O-IYOUR E-MAIL ADDRESS
SITE ADDRESS 0 y® ST 1 ^fS 6 iJ 6 L J 0
THIS APPLICANT IS: 0 OWNER NTRACTOR
PROPERTY
NAME: 1-1 1 2 L V.4-ZEEAbP–IJ
ADDRESS: ®S� $T 0 J�Q 5 bN� 64.o&CITY i�liJ t1 L STATE�a�ZIP r`�-��
OWNER/
TENANT
PHONE: 6 3 .. 3 0 0 - � S� 9 ( A.
CONTRACTOR
NAME: "IF- AL y 0 () A-2 A ¢, I6 6 J2. RZ a /h aS J .J 6 , 'j G
STATE LICENSE # S 1 +4 `f P AJC EXP DATE
C T u d CITY SPA J s16 L,+Ic E ek STATIA A) 3'134
SUBMIT A COPY OF
YOUR STATE
ADDRESS: / 6" v j y .46
LICENSE WITH
PHONE % L 3 5-1a <PS -fb FAX
APPLICATION
PERMIT TYPE
0 SINGLE FAMILY n TWO 0 TOWNHOUSE
I�FAMILY
o HPLACEMENT
TYPE OF WORK:
NEW
DETAILED DESCRIPTION OF WORK W -3)
PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $900.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor _ X.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SINK/LAV FLOOR DRAINS _ SHOWER— WATER PIPING
BATHTUB GAS PIPING (Am) cm acm%) SWIMMM POOL WATER SOFTNER ($35)
— ~ —
CLOTHES WASHER KITCHEN SINK WATER CLOSET • BACKFLOW PREV. ($15)
DISHWASHER _ LAUNDRY TRAY ,WATER HEATER ($35) FOR IRRIGATION
OTHER
_ WATER METER _„_,
<.
Permit Fee $ .0 u Number of fixtures @ $10.00 x $10.00 $
Surchar a .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ Number of fixtures @ $35.00 x $35.00 = $
___3.
State Surcharge = $ .50
Total = $
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
0
SIGNATURE OF APPLICANT g 9 PRINT NAME A e4 E 2 0 DATE L
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, -MN 55432
763-572-3604
FAX: 763-502-4977
Building
BUILDING
Permit No.:�
Inspections
RESIDENTIAL APPLICATION
Received
763-572-3604
�. 2009
CITY OF FRIDLEY
n
763-502-4977 FAX
EFFECTIVE 1-1-09
DATE ��— 9
YOUR E-MAIL ADDRESS
SITE ADDRESS 60-0 SWnSP., 64,&J 0),V S S-tl 3 2t
THIS APPLICANT IS:
❑ OWNER ONTRACTOR
PROPERTY OWNER/
NAME: EZ9b eAJ
TENANT
ADDRESS:®� fy'�.®� �(y� CITY �LIV-1n
STATE n7A0 ZIP
PHONE: 610A-- 91a
CONTRACTOR
NAME: Cisc4po 1-1®roe's °` RW~De--wCa_ 44-c
STATE LICENSE # 2_®.5`V1/2 7 a EXP DATE
3-31 "' to
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
/,,
ADDRESS: !" F6 .te/lt WJ,0 PR 4-/ CITY 4fPW. f14 -LLQ j STATE ZIP 1-:11
INSURANCE
PHONE 6.2 —Cf'St - Y> FAX
PROPERTY TYPE
WINGLE FAMILYINEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED A0VINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR REMODELING
DESCRIBE WORK BEING DONE: &."A1, i00 A�4M V I -
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
❑ HOUSE & GARAGE
1.
Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
[]Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
l .
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,*Ies ❑No 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:
SING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee $ See Back Page for Fee Schedule
Plan Review $ T T� 65% of Building Permit Fee
Fire Surcharge $ .001 times the total job valuation
Surcharge $ !E t 3 .0005 x Permit Valuation Minimum $.50
License Surcharge $ , 60 $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 $22 = $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( }
Total Due $ ® VMake checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of all y9rk whi requires review and approval of plans. �q
SIGNATURE OF APPLICANT PRINT NAMESI,Q AwglAn DATE
Page 2 - Building Residential Application
BUILDING PERMIT 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 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
FEES
$1 to $500
$23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000
$23,50 for 1' $500 plus $3.05 for each additional $100 or fraction, to and
including $2,000
$2,001 to $25,000
$69.25 for 1" $2,000 plus $14 for each additional $1,000 or fraction, to and
including $$25,000
$25,001 to $50,000
$391.25 for 1$` $25,000 plus $10.10 for each additional $1,000 or fraction,
to and including $50,000
$50,001 to $100,000
$643.75 for 1' $50,000 plus $7 for each additional $1,000 or fraction to and
including $100,000
$100,001 to $500,000
$993.75 for 1 s' $100,000 plus $5.60 for each additional $1,000 or fraction to
and including $500,000
$500,001 to $1,000,000
$3,233.75 for the 1' $500,000 plus $4.75 for each additional $1,000 or
fraction to and including $1,000,000
$1,000,001 and up
$5,608.75 for the I' $1,000,000 plus $3.15 for each additional $1,000 or
[fraction
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Only
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, NIN 55432
763-572-3604
Fax: 763-502-4977
Building
$ "�, d P `�
BUILDING
Permit No.:
Inspections
65% of Building Permit Fee
RESIDENTIAL APPLICATION
Received By:
763-572-3604
763-502-4977 FAX
CITY OF FRIDLEY
Date _ .
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
EFFECTIVE 1-1-2010
Curb Cut Escrow
61- 2-1 — i
0 t e•^ �C'ry
p ( C ® `�
DATE YOUR E-MAIL ADDRESS (�
SITE ADDRESS 6o 57c3 st,_,v5vy 1?(w , IV 4!5- re"-eC�K r ✓✓)
THIS APPLICANT IS:
OWNER ❑CONTRACTOR
$
PROPERTY OWNER/
NAME: J 'es Uckw
$
TENANT
✓t � �'�
ADDRESS: 6 v % s-� r ... Sd ,,, � r v oQ. Ale CITY
STATEM°v' ZIP S5,c13z
Make checks vavable to: City of Fridlev Attach Stipulations
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
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS
❑ BASEMENT FINISH ROOF ❑ DRAIN TILE
❑ DECK SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: '4/ e_c" '^00-14'
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFINGQ HOUSE ONLY
NUMBER OF SQUARES 2 HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
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 1. 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:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATIONS a� OCCUPANCY TYPE
Permit Fee
$ "�, d P `�
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$ V
001 times the total job valuation
Surcharge
$ 16
.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
$ d
Make checks vavable to: City 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 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 1
work which reyui s review and approval of plans. _
SIGNATURE OF APPLIC Cv-- , V' PRINT NAME,.) A—""y L/Q1 Zf el-ef l DATE 9
Page 2 - Building Residential Application
BUILDING PERMIT 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 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
FEES
$1 to $500
$23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000
$23,50 for 1' $500 plus $3.05 for each additional $100 or fraction, to and
including $2,000
$2,001 to $25,000
$69.25 for Y" $2,000 plus $14 for each additional $1,000 or fraction, to and
including $$25,000
$25,001 to $50,000
$391.25 for Ig $25,000 plus $10.10 for each additional $1,000 or fraction,
to and including $50,000
$50,001 to $100,000
$643.75 for 1' $50,000 plus $7 for each additional $1,000 or fraction to and
including $100,000
$100,001 to $500,000
$993.75 for V'$100,000 plus $5.60 for each additional $1,000 or fraction to
and including $500,000
$500,001 to $1,000,000
$3,233.75 for the 1' $500,000 plus $4.75 for each additional $1,000 or
fraction to and including $1,000,000
$1,000,001 and up
$5,608.75 for the 1' $1,000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site.
A. Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Only
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, NIN 55432
763-572-3604
Fax: 763-502-4977