PRE 2010 DOCSN? 690
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Builder_
Front Del 1h
To be used as_____
' a
Village of Fridley, Mia�tu.
BUILDING PERMIT
Office of INSPECTOR OF BUIMINGS
Fridley, Minn.,
LOCATION OF BUILDING
Street :of Lot
Block Addition or Sub -Division
DESCRIPTION OF BUILDING
Hei�.9ght Stories a Manner of Construction
`= To be completed a"�` ! ' Estimated Cost
Permit is hereby, granted to to
described In the above statement. This .
the building '`' � permit is granted
upon the express c d"Jon that the person to whom it is granted, and his ' agentq� employees and workmen, in all
the work done in, iaround and upon said building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley, j' Minn., regarding the construction, alteration, maintenance, repair and moving of buildings
within the city limrlts, and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
—,
Inspector of Buildings.
u
AGREEMENT AND SWORN STATEMENT
In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of
the above pe `t, I hereby agree to do the proposed work in accordance with the description
above set forth land according to the provisions of the ordinances of "Fridley, and, being first duly
sworn, I hereby state and say that the facts stated by me and contained in the above permit are
true as therein stated.
SubscriWed at d sworn to before me at Fridley, Minneqgtg, this-
day
his day of A,..,: - _
SUBJECT
P T NO.
City ®f Fridley
21
1.6.7
AT THE TOP OF THE TWINS
BUILDING PERMIT
r09
I L
CEIPT NO
• _____ COMMUNITY DEVELOPMENT DIV.
SEC.
PROTECTIVE INSPECTION
-`1 CITY HALL FRIDLEY 55432
NUMBER
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
TREV.
6/2/81
JOB ADDRESS 6160 Sunrise Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
24
2
Sylvan Hills; SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Robert Peterson 6160 Sunrise Drive N.E. 571-1086
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Dale H. Peterson 19014 Wolfram.St. N.W., Anoka, MN 753-1663
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 a 151611 x 14' Ad '.tion and an 8' x 14' Deck onto Dwelling
9 CHANGE OF USE FROM TO
.STIPULATIONS
SEPEIZAT'E -PERMITS REQUIRED FOR 'WORI C!,
G4L FM AM 4 90Wn0ft HEA 71NG. PLUMBING AND SIGNS
Final Ins cti0ns Of an
r�QquirU+°
*r
WARNING
l
Before 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
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
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
$91300
$4.65
WITH WHETHER SPECIFIED E OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO E AU HOVY TO VIOLATE OR CANC L T E
PERMIT FEE
SAC CHARGE
—
PROVISI N OF ANY - ER STA E ,R LOCAL LAW REGULATI N—
$57. DO
NONE
STRUC 10 OR THE FORMA CE CONSTRUCTION.
S
PLAN CHECK FEE
TOTAL FEE
$14.25
$75.90
NATURE F NTR OR OR AUTHORIZED AGENT tD EI
WHEN. PROPERLY VALIDATED THIS IS YOUR PERMIT
BLDG rATE a�
SIGNATURE OF OWNER OF OWNER BUILDER) (DATE)
CITY OF F1tIDLCY
APPI-ICATIO'd FOR RESIDENTIAL BUILDING PEMITS
(New, Alterations, Additions, or Repairs)
OWNER:
ADDRESS:
TEL NO: =/ /®Fr60
BUILDER:��- ! l� l�d�✓
ADDRESS:
TEL NO: l,6;,63
Construction Location '
STREET NO: 01400 STREET: Sy /U /Z P12- �
LOT: BLOC`..t:: ADDITION:
Corner Lot: Inside Lot: Setback.: � Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION -
• l4,®®1rodj Front: �5-� Depth: / r Height: r
Square. Feet: I Cubic Feet:
Front: Depth: Height:
Square - Feet: '� Cubic Feet:
Type of Construction: /�si?F� Estimated Cost: $
To to Completed: .9-0
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired:
SEI: REVERSE SIDE OF SHEET .
Ilie undersigned hereby, makes application for a permit for the %.,ork' herein specified,
agreeing to do,all work in strict accordance with the Cityo Fridley ordinances and
rulings of the Departn�.ent of Buildings, andy declar s a a the facts and
represcn tzti.oi statd 4V this application ZrE true c . rec -
DATE.: �''// -7 /(-- / SIGNATURE::
Stipulations; /
r
00
1 .
. BUH-DING�PrIT FEE `;CII )ULE-�
:;)SC:'C[OI7 ?_. 'J'hl� 7iv.;pector. of 131Ii.ldi.n(i ; :chrlJ.J., befoY:c: )�cnnit" for the crection
of any buil(l.i.YIrl or :,t:�'uC t:tYY:c, Or: fa): any addi.t-Jon to any exist:irlg building or ,;tructur-e,
6): fo)*- any alto -ration or. repairs to -any c>:i.:.l:.i.n�i lnli.J.di:Ilc; or stzucturc, upon ar�l�la.cati.on
thorefor.cs, requ.i.Y:e Ur,_, payinent: by the appli:c:arlt: fciY- :;uch permit of fec> to t11e amount
her_ui.n bCl.ow sc:t forth and i.II Clic munrler hp.ci.rl provid(.-d to-%..'i:t:
NEE Collsi7:tftION: Single 3.'Z111il.y homes and C}a).,-iges: ;:4.00/1,000 cubic feta:.
P7,hN CHN'CK: 25 percent of l)uilding J.sermit fee.
UR1VIit;A1' DBPP.i:SSIOI•:: (Concrete. C uxb Streets Only)
Altcrrlat:e A: Retnoval and replacement of concrete curb and
gutter only; Driveway widtlY plus 6 feet x $13.50
Alternate B: Removal and replacement of concrete curb and
• gutter and install. a 3 foot wide approach with • .
6 inch depth; Driveway width plus 6 feet x $15.,75
. AD IT10NIAL INFORMA TON
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 average height of the roof surface
of the ;gain gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the rate
of $3.00 pier each five hundred dollars "($500.00) or fraction thereof in the cost
of all proposed work. -
In -no case sha.11 'the fee charged for any permit as set forth in' Section 2 be less
than $7.50 plus $.50 state surcharge.
-RTFICI TION! QF F U (DATION
NOTE: Permits for construction will be issued a minimum of 24 hours from the time
Of-: application to allow for proper review of the proposed structure and of the
construction site.
J
A Certificate;of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the ..framing.
._Lt:.QLI F I CITE OF OCCUPANCY
Application for a Certificate of occupancy shall be mad, ten (10) dziys prior to the
use or Occupancy of any structure for which a building permit l.as been issued; and_
stcid struct:urc hall not be used or occupied uIltil a Certj.fi.cate of Occupancy has
been issued.
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777777
ADD AH9, { ;
o ,
'. ? c ✓`� :f h; rn�� •f a '�d�' F 6� '*$kkt Ll r3 +$..j;t; �M��S � 'WR
u4
total .a11 ak'rmer A® s Yk
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b�tL It w, t a, { �
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IS
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Ril
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l: y S }•, a 1 p k p.' Y t Yr':w �-.
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CARPENTER
15104WoLFRANI sT. N. A%*. 753-1663
ANOKA, MINN. 65308
47%L
x
O'l
DALE' Jr. 1"E'TEMSON
M -- 1.1, ,
INTIEIt
Al PE
W. -,5.1-1ow)
ANOI(Ai MINN. 65303
CITY OF FRIDLEY
Effective Date May 1. 1988
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
QESIDE)bTLAL �� `
Furnace Shell a' Duct Work,
Burner (Also replacement furnace)
Gas Piping O
(piping need ith new f ce)
Gas Range
Gas Dryer
• Air Conditioning (all sizes)
RATE TOTAL
$ 20.00 $cl
�
$ 10.00 $
$ 10.00 $
$ 10.00 $
$ 10.00 $"
All Others/Repairs and Alterations
li of Value of Appliance or Work $
COMMERCIAL/INDUSTRIAL
1• of Value of Appliance or Work $
State Surcharge $ .50
TOTAL FEE
Reinspection Fee ($15.00) $
Rough Insp.
Date
Final Insp. I a (®-9 _;
Date
rn
Approval for Permit 2,'
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00
PLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
Job Address 6 t16 o1 1// 'A
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
City of Fridley
Tel. 11571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
/11) Fridley, Minn. l — �51 7 '19-93
OWNER
KIND OF BUILDING �✓ -ylot
A „ /J
USED AS
TO BE COMPLETED ABOUT
�y
ESTIMATED COST ` U
9LDNEW BUILDING PERMIT NO. PERMIT NO.
DESCRIPTION OF FURNACE/BURNER
EATING or POWER PLANTS, Steam, Hot Water, rm Ai No.
Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Total Connected Load ��s�Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Company
Signed By
Tel. No. �Zy :7
Fill out back side for stack verification on replacement furnaces
CHIMNEY AND STACK 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 ( )
No ( )
3.
Has no foreign objects lodged within
Yes ( )
No ( )
4.
Is securely supported
Yes ( )
No ( )
5. Meets all current Code requirements for size and
total BTU connected Yes ( ) No ( )
6. Has Total heating BTU's of
All other BTU's
TOTAL
Rema rk s,�,c�
CompanyCuu-
Ay-
Signed By
Date / 7
SUBJECT
PER
City ®f Fridley
2671
AT THE TOP OF THE TWINS
BUILDING
MIT
•
',
IPT NO.
COMMUNITY DEVELOPMENT DIV.
tiO
/�
qq
I PROTECTIVE INSPECTION SEC.
r
`od'dp
,
NUMBER
REV
DATEPAGE
OF
APPROVED BY
I 1 CITY HALL FRIDLEY 55432
ti.___.i�.' '•�
612-571-3450
9t0-Ft5
7/2 0/98
/
JOB ADDRESS 6160 Sunrise Drive
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
24
2
ISylvan Hills
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Randy Hanson
572-8747
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
New Haven Const. 4208 83rd Ave N Brookl3m
Park MN 55443
66-5225 20077950
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 )0 REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof (22 Sq) Tear -off
9 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with 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 BO 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
OFFST.REET 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
$.92
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1834
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE Inv Fee
SAC CHARGE
PROVISIONS OF ANY .OTHER TATE LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFOR CONSTRUCTION.
$59.50 $59.50
Fire SC $1.83
ANCE
I �
PLAN CHECK FEE
,7icenee SC $5.00
TOTAL FEE
$126.75
- SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DAT IWHEN�P�yRO�PERLY
LIDATED
X70
13LOO INSP
THIS IS YOUR PERMIT
DATE
_
SIGNATURE OF OWNER IIF OWNER BUIL DE RI IDATEI
B
rrs� ri --VIP
2- 72
-�.zZ-S—
��M 0 - Ell 6 M � �
59 s�
as S�
9d
S,00
TC
- I .0
Building
Permit Fee
BUILDING
See Back Page for Fee Schedule
Permit No:. -,
Inspections
65% of Building Permit Fee
RESIDENTIAL APPLICATION
Received By:
763-572-3604
Surcharge
CITY OF FRIDLEY
Dat MMNOV
763-502-4977 FAX
$ Soo
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2000 per SAC Unit (Plans to MWCC for determination)
EFFECTIVE 8-19-09
$
ft + 6 R = ft x $22 = $
DATE — ^6YOUR E-MAIL ADDRESS
$
SITE ADDRESS �,(�j t0
��ta/ �! S ®IL N-0
$
THIS APPLICANT IS:
❑ OWNER WONTRACTOR
$
PROPERTY OWNER/
NAME: be L- ou
$ C�u Uz
TENANT
ADDRESS: 6760 ,s'GrvrJ P° e U
CITY 1--g. 4ey STATE POZIP
PHONE: %6.7- CaV — 96/;?
CONTRACTOR
NAME: a e.5:7-- W "'.Ja W
G d
SUBMIT A COPY OF
STATE LICENSE # 2 13 ®
EXP DATE 63 2610
YOUR STATE LICENSE
AND CERTIFICATE OF
ADDRESS: 373 9 /-11,* ty iv
�q
Ave CITY / 4,5 STATE 0X)ZIP "06
INSURANCE
PHONE 61;2 - `7 &2 1-.5`^333
FAX
PROPERTY TYPE
iE SINGLE FAMILY/NEW CONSTRUCTION
SIZE
❑ TWO FAMILY/NEW CONSTRUCTION
STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED
INDOWS
❑ BASEMENT FINISH ❑ ROOF
❑ DRAIN TILE
❑ DECK ❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: �l o`f� ��.- e %� �� GL 6� s2m�7'
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING
b HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
El 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
1. Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
2 Two sets of construction plans
WIIVDOWS
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:
SIING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 6 T 9 ' OCCUPANCY TYPE
Permit Fee
$ ( "4"�)
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$ Soo
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 R = ft x $22 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$ C�u Uz
Make checks Davable 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 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 work which requires review and approval of plans. is
SIGNATURE OF APPLICANT �� PRINT NAME O- P' � � P TIG � 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 V $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 1s' $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 V $500,000 plus $4.75 for each additional $1,000 or
fraction to and including $1,000,000
$1,000,001 and up --J$5,608.75
for the V $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, MN 55432
763-572-3604
Fax: 763-502-4977