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APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER 's NAME 1 t I C f 10 d �! F `� If 1, l l ► �7 BUILDER
ADDRESS�'1j
LOCATION OF BUILDING',
NO.� STRFT
LOT BLOCK� AD ITION OR SUBDIVISION
CORNER LOT INSIDE LOT SETBACK U SIDEYARD �
SEWER EiaDiVATION TOP OF FOOTING
Applicant attach to this form Two Certificates of Survey of Lot and,
proposed building location drawn on these'ICertificates.
DESCRIPTION OF BUILDING
To Be Used As:
Front Depth _ Height
Square feet 440 Cubic Feet
Front Depth Height
Square feet Cubic Feet
Type of Construction Estimated Cost f�"/6o-e
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 ' G �9 SIGNATURE'
(Schedule of Fee Costs can be found on the Reverse Side.)
BUILDING PERMIT*FEE SCFE DULE
SECTION 2. The Inspector of Buildings shall, before issuing permits
for the erection of any building or structure9 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 -wit:
Uniform Building Code: Type 1, 2, & 4 - $1.75 for each one thousand
cubic feet, or fraction thereof, in such cubical contents. Type 3 & 5 -
$1.50 for each one thousand cubic feet.
For the purpose of computing fees for building permits, the cubical
C'Ohtents of 'any 'bui-rdirig--Gr additiou' V "a uniform heist-th-bugho�u.t 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.
� /3(:) HOUSE HEATING TEST
ADDRESS *§0;
; =irkpxVEATLOSS—DATE '051.
SOLD BY
Electrical Work By
TYPE OF HEAT
GA
FA 4" HW
RECORD
_FLOOR CITY —SUBURB...611"
or
INSTALLED BY
Gas Line By —
STEAM SPACE HTR.
r -,—CAS DESIGN
MAKE, MAKE OF BURNER _
Model Model
Serial d �Pcv,;7 !i Max. BTU Rating —
INPUT ^ It'0 6 MAKE OF FURNACE
Model
UNIT HTR. OTHER
CONVERSION
CONTROLS r®
THERMOSTAT Heat Plug _r t -a Vent Size
Valve ' KIND OF LINER '+ SIZE NONE
Limit Draft Hood Regularor
Limit Setting ;&12ii Filters Size ilX Number.
Fan Setting Chimney Location Inside _ /�• Outside
Pilot Type Chimney Construction
�rt'�
Pilot Make
Pilot Model Smoke Bomb Wiring V___
Pilot Timing Draft Test Tag
L.W. Cut Off Door Pressure Lighting Inst.
Pressures Percent CO2 36 Date Tested' 6 6
Input CFH Percent 02 Company Testing
Stack Temp. ��� Percent CO Name of Tester y
Form 235
SUBJECT
PERMIT N
City of Fridley
20845
AT THE TOP OF THE TWINS
B U I L D I PERMIT
r
'?-,
RECEIPT
COMMUNITY DEVELOPMENT DIV.
_
�0 PROTECTIVE INSPECTION SEC.
v
o ,
CITY HALL FRIDLEY 55432
IL"'"'
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
" %•j 612-571-3450
910-F15
5/28/91
JOB ADDRESS M 6130 Sunrise Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
21
2
Sylvan Hills SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Frazee 6130 Sunrise Drive NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
574-9966
Richard Hastings Contractor 6331 Riverview Terrace.NE
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 3 REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Dwelling (13 Squares)
9 CHANGE OF USE FROM TO
STIPULATIONS Roofing can be 2nd layer but not 3rd,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$676,00.
$.50
.WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$19.00
Fire SC $.68
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$20.18
®
-5/a � 6D
WHE PROPS Y V D T -. IS IS YOUR PERMIT
SIGNATURE OF CONTRACTOR ORA HORIZED AGENT (DATE)
/
OG -NSP DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
NEW [ ] Effective 1,/1/91
ADEN [ ] 1-1 AND R-2
ALTER [ ] Building Permit Application
Cmistruction Address: 6130
Legal Description:
Owner Name & Address: �XA Z Tel.
Contractor: a G� A R 0 14A S-?'�' ,V CY Tel. # 5 -7
Address: 6.s36 RavtzR 0nC ' 7-e 1z
Attach to this application, a Certificate of S1UrVW of the
lot, with the proposed oonstrwctian drawn on it to scale.
LIME AREA: length Width Height Sq. Ft.
Qui UM AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Graund Sq. Ft.
07MM:
Corner lot [ ] Inside Litt [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: c, F Estimated Cost: $ o (, ao
Approx. Completion Date: /! 5 / �
Proposed Driveway Width If New opening Is Desired: Ft. $ $
Width + 6' See Back Page
DAZE: APPLICANT: Tel. # 5,2 -If - f e d C
Permit Fee
00
Fire Surge
$
4o
State Surcharge
SAC Cmge
$
Driveway Escrow
$
Park Fee
$
Sewer Main Qkarge $
TOTAL
$
sTzxILATIMS:
t.
CITY USE �Y
Fee Schedule on Reverse Side
.001 x Permit Valuation (1/10th $)
$.50/$1,000 Valuation
$650 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Egg;
Agreement Necessary [ ] Not Newry [ ]
The Chef 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 ammmt
herein below set forth and in the manner herein provided to—wit:
$1 to $500 $15 odnimmm Fee is $15 plus sux-d ge)
$501 to $2,000 $15 for first $500 plus $2 for each additional $100 or
fraction thereof, to and including $2,000
$2,001 to $25,000 $45 for first $2,000 plus $9 for each additional $1,000
or fraction thereof, to and including $25,000
$25,001 to $50,000 $252 for first $25,000 plus $6.50 for each additional $1,000
or fraction thereof, to and including $50,000
$50,001 to $100,000 $414.50 for first $50,000 plus $4.50 for each additional
$1,000 or fraction thereof, to and including $100,000
$100,001 to $500,000 $639.50 for first $100,000 plus $3.50 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for each additional
$1,000 or fraction thereof
EPZVERRY EEPSMSSIM Z9C3W
(Cmx:rete Q rb Streets Only)
Alternate IW": Removal and of curb and gutter only - Driveway width plus
6 feet times $13.50.
Alternate "B": Removal arra replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet timers $15.75.
Permits for construction will be issued a minian 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
it has been constructed will be required before p� -ding with the framing.
BUBJE&
P
City of Fridley
1 1 13
AT THE TOP OF THE TWINS
BUILDING
PERMIT
`
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
4061
CITY HALL FRIDLEY 85432
NUMBER
REV
DATE
PAGE Of
ACPROVED Br
�.___1l•'-, 612-571-3450
914-F15
6/26/00
JOB ADDRESS
6130 Sunrise Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
21
2 .
Sylvan Hills SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Andrea Frazee 6130 Sunrise Drive
571-1354
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Owner
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 Y9 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
16 x 20 Garage addition
9 CHANGE OF USE FROM
TO SEPARAH PERMIT
STIPULATIONS
WIRING HEATING
PWMBINd AND SIONS
Provide truss spec's
Footing. Inspection
WARNING
Framings Inspection
Final Inspection
p
Before di call f®r
SII Utility
y locations
For complete stipulations see attached
plans.454x0002
IREQUIRIED BY LACI
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 1 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
$6 192.00
$3.10
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-
$139.25
Fire SC. $6.19
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL VE
$1.54
SIGNATURE OF CONTRACTOR OR ORIZEO AGENT (DATE,
EN ROPER IDATED IS IS YOUR PERMIT
S-GNATURE OF OWNER,IF OWNER BUILDERS _iDArE,BLOZ
,NSP
NEW I
ADDN 6? 'r d
ALTER [
Construction Addre
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/2000
(763) 572-3604 Bldg Insp
Owner Name & Address: k�&,�e,\ -F�- fiLp EC-. . Tel. # 5 y /- C s b Y
Contractor. 'SCA MN LICENSE #
Address: Tel.# SAdrie-
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
Width
Construction Type: / ',
Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: (4a' (OD— APPLICANT: tjM6W G Tel. # -7 U
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ %�c3 , �S Fee Schedule on Reverse Side
Fire Surcharge $ . f .001 of Permit Valuation (1/10th%)
State Surcharge $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
$_$1 100 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
H
$450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [
.
'<1-41/
TOTAL
TOTAL $ ✓ 1✓ ;dec
STIPULATIONS: �tl
IfF A 10 /
. f/e�
BUILDING PERNM 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
$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
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional. $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each 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 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 it has been constructed will
be required before proceeding with the framing. New Houses Only
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m
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