PRE 2010 DOCSVI Mlage of Fridley,, Minn.
BUMBING PFAMri,
r �
Village of Frhuey, MI.
BUILDING PERFM
N.o
627
Office of INSPECWB OF BUILDINGS
owner,
Architect Fridley, Minn.. 19
Builder
LOCATION OF BUILDING
NO. Qtr Street Part of Lot
Lot Block Addition or Sub -Division
d
DESCRIPTION OF BUILDING
Front L 'L Depl�h y a Height --L Stories Manner of Construction -
To be used as To be completed Estimated Cost
Permit is hereby to
_.
a y
the building described in the above statement. This permit is granted
upon the express condition that the person to whom it is granted, and his agents✓ employees and workmen, in all
the work done in,round and upon ,said building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley, ,!Minn., regarding the construction, alteration, maintenance, repair and moving of buildings
within the city limits, and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
inspector of Buildings.
�f AGREEMENT AND SWORN STATEMENT.'
In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of
the above permt, I hereby agree to do the proposed work in accordance with the description
above set forth end according to the provisions of the ordinances of Fridley, and, being first duly
sworn, I hereby:state and say that the facts stinted by me and contained in the above permit are
true as therein stated.
Subscriibed andlsworn to before me at Fridley, Minnesota, this -"
day of A -D. 19
SUBJECT
PER
City of Fridley
1 6034
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
P
6
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
i CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
112/16/80
JOB ADDRESS 105 Talmadge Way N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
Elwell's Riverside Heights SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Dale Severson 105 Talmadge Way N.E. 571-0402
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 28' x 24' Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide a hard surface driveway.
SEPERATE PERMITS
� FoR
EATING. PLUMBING
AND
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
$5,920
$2'96
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
PROV ANY OTHER STATE OR LOCAL LAW REGULATING GON-
$26.88
G HE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$29.84
EOF COVZACTORORAUTHORIZEDAGENT (DATE)
W EN PROP LY D E HIS IS YOUR PERMIT
SIGNATURE OF OWNER I IF OWNER BUILDER) (DATE)
DG )NSP GATE
CITY OF FftIDLEY
APPLICATION F=OR Rf:Sir�c:NTIAL BUILDING PEMITS
Wew, Alterations, Additions, or Repairs)
OWNER: ag l e W. cv e v�r,� a,� BUILDER: .fie ��raJe Se vers®t,,
ADDRESS: JoS Togij ,g �2r'. "� ADDRESS: /o s l�JlrnAdgeTEL NO: _S,r- o qo,2 TEL NO: 5 7 ( - O L(g_
Construction Location
STREET NO.- bs STREET: YA /'"'q A q a �y
LOT: ,-- o°Z BLOCK: 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 CO.INSTRUCTION
Front: OR Depth: Height:
Square.Feet-: 'L Cubic -Feet:
Front: Depth: Height:
Square - Feet: Cubic feet:
s&N
Type of Construction: Estimated Cost:
i
%b Be Completed:
Alt. A Alt, B
Proposed Driveway Width If New Opening Is Desired: $ ' $
SEE REVERSE SIDE OF SHEET
The undersigned ]iereby makes application for a permit for the uork' herein specified,
agreeing to do.all work in strict accordance with the City of rridley Ordinances and '
rulings of the Depart-ment of Buildings, and hereby declares that all the facts and
represen tzati.ons stated in this application are true and correct.
D.,%TE: 1a2 -Is' • go
Stii)ulations :
L
a9.�y
SIGNATur,E..
r
Bu1Li)111G�i'f;fttll't FEE sc:c►r:r.�utl
SIX-TI01•I 2. '1.fit ! T:n�;pcctor of nkli.lditul . t:hrtl.1, before i. ,tzi.ng pennits for the crection
of ally buil (IIIb) or. :structure, 03: for ility ilddi.ti011 +.:o any exi:;tittg buildin(j or stxucturr.,
6): for any alteration or repairs; to -ally exi.::t:ing hui.l.di,,r; or stzucture, upon application
thnru. fore, require dic paymcid. by the applicant for such permit of fees to tltb ainount
hcrtAn below set forth and ill tlic manner herein pro.,id(!cl to -wit:
131:1•] C014mInUCTION: Single Family Domes and Garactes: ,:4.00/1,000 cubic feta:.
3?JAIi CIIJT : 25 percent: of building I_)crmit fee.
DRIVEWAY DEER SSIOi:: (Concrete. Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only.; Driveway.width .plus 6 feet x x:15.75
Alternate B: Removal and replacemcnt of concrete curb and
gutter and install a 3 foot wide approach with
6 inch depth; Driveway width plus 6 feet x $17.85
ADDITIONAL INFORMATION
For the pur}�se 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 main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the rate
of $3.00 tier each five hundred dollars .• ($500.00) or fraction thereof in the cost
of all proposed work.
in -no case shall_ the fee charge,:_ for any permit as `set . forth in Section. 2 be less
titan $7.50 plus $.50 state surcharge.
VERI F I CTI Oft OF FOU.NDAI I0t1
NOTE: Permits for construction will be issued a minimum of 24 hours from the time
of application to allow for proper review of the proposed structure and of the
construction site.
A 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.
TIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be mad; ten (10) days prior to the
use or occupancy of any structure for which a building permit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
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DAtC
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City ®f Fridley
SUBJECT
R
-1618 6
AT THE 70P OF THE TWINS
B' I L D I i� B %� ®[ D w A I T
BUILDING
_
r
`EIPT
V v r LR�v�
NO.
• COMMUNITY DEVELOPMENT DIV.
r � e PROTECTIVE INSPECTION SEC.
--'1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
15/14/81
PAGE OF
APPROVED BY
612-571-3450
910-F15
JOB ADDRESS 105 Talmadge Wsy N. E:
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
1,2
1
Elwell's Riverside Heights SHEET
2 PROPERTY OW 4� R - MAIL ADDRESS ZIP PHONE
Dale 105 Talmadge Way N.E:, Fridley, MN 571-0402
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
x
8 DESCRIBE WORK
Construct a 301-x 26' Detached Gara e
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide a hard surface driveway.
This is a renewal of Building Pewit #16034, because of non-use within 60 days
of issuance, Frith. a change in the s-ize and location of garage.
We are collecting only the difference in the amount of the permit fee and
state surcharge and reporting only the difference in the valuation.
WARNING
SEPE'RATE PERMITS REQUIRED FOR i�lf�INC4
Before digging call local ntifitiea
TELEPHONE -ELECTRIC - GAS Etc. HEATING. PLUMBING AND SIGNS. -
REQUIRED BY LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame rame
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
7800
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
780
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
Z
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
$1,451
$.73
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-
$4.32
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$5.05
IGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
EN PROP L AT D THIS IS YOUR PERMIT
all
A
G INSP DATE
SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI
CITY OF FRIDLEY
APPLICA'tim FOR RESIDENTIAL BUILDING PER11ITS
(New, Alterations, Additions, or Repairs)
OWNER: C�� . S&JeSe--�QAJ BUILDER:
ADDRESS. 144=d2R®�� ADDRESS:
TEL NO: 2`'71- n -'O-2 TEL NO:
Construction Location '
STRM— T ,NO: 1®C� STREET: /A� /1`IAb� c� LL'�A� ,u(<�.
LOT: ��� BLOCK: / ADDIT1014:
Corner Lot: tZ 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
C�4,C.l a Front: ® Depth: Height: /0
Square. Feet_Cubic Feet: %�®D
Front : Depth: Height:
Square - Feet: Cubic Feet:
Type of Construction: /—,ewm Estimated Cost: $
To Be Completed:
c
Alt. A Alt. B
Proposed Drivei•ray Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET .
The undersigned hereby makes application for a permit for the tnrk' 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.
MTE: SICNATU_,R'r'. :
Stipulations: �,� � lJ` �C� A /�e-b Tu -ea
t
W
13UJL1)11,lG I1c_r11'1T FEE 1';(AjF')U1_E- �
Sl-:r'.1OH 2. - I'ltct. 7nv.:liector of Mlildiiu{; shall, before it;:;u.i.tu{ perlaits for t.tic crection
of any bui.l.rl. nu or ,;tructur:c' or: for ally addition to tidy rr..isti.iul builclirtg or :;tzlict:ur. .
crr- f.`crr my al.t.rration or r(Tai.r.s; to •any eXiSU"c{ hui.l.di.ii.{ or. .;t):uct:urc, Upon applirati.on
thcr:cfor.c, r:equIre tiro payment: by U10 appl.i.c:arit for strclr }emit: of fees to the amount
hCre.i.rr 1301.01.1 set fortis and ili Hie manner: herci.n f)r:ovicic!cl to-td:i.t:
1F'11 CONSTRUCTION: Single 1. zmil.y home.; and Garlic {es: ,4.00/1,000 cubic feta:.
VJ,7 CIIF.CK: 25 percetit: of lrui.ldi.ncj jKr:mit fee.
DRIVI'MAY DEPR SS2OId: (Concrete. CLixb :streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x $13.50
Alternate B: Removal and r.epl.accn:c•nt of concrete curb and
• gutter and install a 3 foot aide approach wigs
6 inch depth; *Drive;•tay width plus 6 feet x $15.75
. ADD -I] onAL r NFOMMA-T 1 ON
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 sig: (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 main gable of a pitched roof.
For repairs or altorations to an existing strticture, the fee shall be at the rate
..of .$3.00 &r 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 $7.50.plus $.50 state surcharge.
VER F j QATI OU of EQUIRDAT z ori
NOTE: Permits for construction will be issued a minimimn 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, shot,*ing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
I
.—U ALF 1 G (TE OE QIU1P 1� \1Q
Application for a Certificate of Occupancy shalt be made ten (10) days prior to the
use or: occupancy of any structure for: which a builtii.ng permit has been issued; and
said structure shall not be used or. occupied until a Certificate of Occupancy has
been issued.
.
t
?5th
W0
CC)NC. CURB e GUTTER
ELF -Y. - 90.56
SC
------ EXIST. CONTOUR
------- PROP. CONTOUR
PROP. GARAGE FLOOR = 92.0
SITE PLAN
PART OF LOTS 18 Z
BLOC; I, ELWELL"S
RIVERSIDE HEIGHTS
97Q2;-bl6o5l CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING P8FMIT
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: N0.
RATE
►n
Number Fixtures
x
$3.00
n
Future Fixture Opening
x
oa
$
Water
x
$2.00
4
•.cin
o
$5.00
W
b$4
W
w
$
100,000 BTU to 199,000 BTU
Heater
.Am+
Le 0
09
x
$7.00
$
New Ground Run Old Building
x
$5.00
$
Electric Water Heater
x
$5.00
$
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1st
r
inge,
2nd
3rd
4th
(R) - Future Connection Opening
Connected with Sewer
(*) - New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: N0.
RATE
TOTAL
Number Fixtures
x
$3.00
$
Future Fixture Opening
x
$2.00
$
New Fixture, Old Opening
x
$2.00
$
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTU
x
$5.00
$
100,000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7.00
$
New Ground Run Old Building
x
$5.00
$
Electric Water Heater
x
$5.00
$
GAS FITTING FEES:
1st 3 fixtures x •$3.00 $
Additional Fixtures x $1.00 $
Gas Range to 199,000 BT(J x $10.00 $ �-
REPAIRS $ ALTERATIONS
First $100.00 $5.00 $
each add. $100.00 or fraction $2.00 $
State Surcharge $ .50
00
TOTAL FEE $ 8 •
REINSPECTION FEE
(510.00)
i
Job Address 105 Talmadge Way -NE
Department of Buildings
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the cork 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
Fridley, Mn. 8-29-78 , 19
OWNER ^ANIELS
RIND OF BUILDING'ra.me
USED AS res.
TO BE COMPLETED ABOUT 9-5-78
ESTIMATED COST 20.00 s �
OLD - NEW BUILDING PERMIT NO. PERMIT NO. /13
Company
Signed By MINNEGASCO
Tel. No.
ROUGH INS..
Date
r '
FINAL INSP.
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLUS $.50 STATE SUFE
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures $ 5.00 $
Future Fixtures S 3.50 S
Old Opening, New Fixture $ 1.50 $
Beer Dispenser S 4.00 $
Blow Off Basin $ 5.00 $
Catch Basin $ 5.00 $
Rain Water Leader S 5.00 $
Hydraulic Valve S 5.00 $
Sump or Receiving Tank S 5.00 $
Water Treating Appliance $ 7.00 $
Hot Watgr Heater �_ $ 5.00 $ .-OG
Gas Range $ 10.00 $
Gas Dryer $ 10.00 $
Back Flow Preventer Required. . . Yes ( ) No ( )
Type $ 5.00 $
ALL OTHCRS AND/OR REPAIRS AND ALTERATIONS
Is of Value of Fixture or Appliance $ fZb
Reinspection F"e $ State Surcharge $ .50
• ($15.00) TOTAL FEE $
Effective Date May 1, 1988
Job Address)(0,z
Department of Buildings
City of Fridley
Tel. #571-3450
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
Fridley, Mn. zz , qlffi
OWNER `1`-Qr no
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT
ESTIMATED COST Z-) (0 C0 . 0 c) / ]
OLD - NEW BUILDING PERMIT NO. PERMIT NO. l bO
Company —ppgp� ;nom n
Signed B3R905 CARED) p A-VEW1 19- �'1---
Tel. J41NNEAPOLIS, MINNESOTA ' = :-
827-4033 - 827-43II
ROUGH INSP.
Date
FINAL INSP.
%te
APPROVAL FOR PERMIT
IS4YD
N
IMUM FEE FOR ANY PLUMBING PERMIT IS $15.00
S THE $.50 STATE SURCHARGE
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2nd
3rd
4th
—L±
L
(R) C Future Connection opening
-
Connected with Sewer
(*) s New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures $ 5.00 $
Future Fixtures S 3.50 S
Old Opening, New Fixture $ 1.50 $
Beer Dispenser S 4.00 $
Blow Off Basin $ 5.00 $
Catch Basin $ 5.00 $
Rain Water Leader S 5.00 $
Hydraulic Valve S 5.00 $
Sump or Receiving Tank S 5.00 $
Water Treating Appliance $ 7.00 $
Hot Watgr Heater �_ $ 5.00 $ .-OG
Gas Range $ 10.00 $
Gas Dryer $ 10.00 $
Back Flow Preventer Required. . . Yes ( ) No ( )
Type $ 5.00 $
ALL OTHCRS AND/OR REPAIRS AND ALTERATIONS
Is of Value of Fixture or Appliance $ fZb
Reinspection F"e $ State Surcharge $ .50
• ($15.00) TOTAL FEE $
Effective Date May 1, 1988
Job Address)(0,z
Department of Buildings
City of Fridley
Tel. #571-3450
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
Fridley, Mn. zz , qlffi
OWNER `1`-Qr no
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT
ESTIMATED COST Z-) (0 C0 . 0 c) / ]
OLD - NEW BUILDING PERMIT NO. PERMIT NO. l bO
Company —ppgp� ;nom n
Signed B3R905 CARED) p A-VEW1 19- �'1---
Tel. J41NNEAPOLIS, MINNESOTA ' = :-
827-4033 - 827-43II
ROUGH INSP.
Date
FINAL INSP.
%te
APPROVAL FOR PERMIT
IS4YD
N
IMUM FEE FOR ANY PLUMBING PERMIT IS $15.00
S THE $.50 STATE SURCHARGE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-3604 YAX: (763)571-1287
ADDRESS : 105 TALMADGE WAY NE
PIN : 103024130003
LEGAL DESC : UNAVAILABLE
: LOT BLOCK
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING
PE O.: 2004-01957
DATE IS 2004
VALUATION : $ 2,504.00
NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE. REROOF HOUSE (21 SQ) TEAR -OFF.
APPLICANT
SEVERSON CORY R & LESLIE B
105 TALMADGE WAY NE
FRIDLEY, MN 55432
OWNER
SEVERSON CORY R & LESLIE B
105 TALMADGE WAY NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The
granting of a permi oes not presume to give authority to
violate or cancelprovisions of any other state or local law
regu cons cion or the performance of construction. _
Bldg Insp
BUILDING PERMIT FEE
FIRE SURCHARGE
STATE SURCHARGE, VALUE
TOTAL
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
83.25
2.50
1.25
87.00
NEW [ ] CITY OF FRIDLEY C* Effective 4/1/2004
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 GG' (763) 572-3604 Bldg Insp
ALTER [ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax --
BUILDING PERMIT APPLICATION C `
Construction Address: °�`� ✓���P��/
Legal Description:
Owner Name & Address: Tel. #
Contractor. `� �le MN LICENSE #
Address: le) Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft
OTHER: 12 e boa ���� `Z 9 S� u c s % ��r d F -F
Construction Type: Estimated Cost: $
Driveway Curb Cut Width Needed: Ft + 6 F = Ft x $ =$ '
DATE: J ell 5-/ i APPLICANT: z Tel. #
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
CITY USE ONLY -
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
l
TOTAL $ Ca STIPULATIONS:
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
$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
FEES
$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
CURB CUT ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate
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.
VERIFICATION OF FOUNDATION
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
Building
$ r %
BUILDING
Plan Review
Permit No.: o004 -,0/
Inspections
Surcharge
RESIDENTIAL APPLICATION
(.0005) times the total job valuation – Minimum $.50
Received By:
763-572-3604
.001 x Permit Valuation (1/10%)
CITY OF FRIDLEY
$
Date Rec'd:
DATE f'r /U�
YOUR E-MAIL ADDRESS • S�'r?��'d. ^-� �<- Co w
SITE ADDRESS %J S l +�Q�s c �,✓ ` Y
Curb Cut Escrow
THIS APPLICANT IS:
P6WNER ❑CONTRACTOR
Erosion Control
PROPERTY OWNER/
NAME: (va,y 5eofr ogn
Park Fee
TENANT
ADDRESS: /d S— % /ter a ire c1r0� / CITY�"! • 2
STATW*ZIP i 5'`Y
$
PHONE:
Total Due
CONTRACTOR
NAME_ Ca✓ C�^
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
INGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION JKGARAGEISHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:NE
❑ ADDITION
MAW
❑ INTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: S° r'a of /2K1� 5&t
SIZE OF IMPROVEMENT / LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
2.
Existing Floor Plan
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.
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS ❑Yes []No LOCATION OF WINDOWS
3.
Energy Calculations
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:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 1650 — OCCUPANCY TYPE
Permit Fee
$ r %
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Surcharge
$ - ®
(.0005) times the total job valuation – Minimum $.50
Fire Surcharge
$ . ®(D
.001 x Permit Valuation (1/10%)
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $20 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$ S�
Make checks payable to: City of Fridley Attach Stipulations
THIS I$ AN APPLICATION FOR A PERMIT -NOT VALID UNTIL. PROCESSED
I hereby apply for a building permit d I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances an 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 permit and work is not to start without a pe it; that the work will be in accordance with the approved
plan in the case of all work whi a uire v and approval of plans.
OF APPLICANT L� PRINT N `° ��` c, DATE 01-160,15—
SIGNATURE
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 1s` $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 I' $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 1s' $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, MN 55432
763-572-3604
Fax: 763-502-4977
7ti4, cc/s G
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k
�yok,
ell
D
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P
C�'66s- 01'9 6 s -
Building
$ See Back Page for Fee Schedule
(BUILDING
$ ,R
Permit No.:
Inspections
$
RESIDENTIAL APPLICATION
Fire Surcharge
Received By:
763-572-3604A77/49/t,579
License Surcharge
CITY OF FRIDLEY
$5.00 (State Licensed Residential Contractors)
Date Rec'd:
DATE �l2 `� /�S—
YOUR E-MAIL ADDRESS C11—f. 5@vCvse'
Curb Cut Escrow
SITE ADDRESS 1057 %^�
I t.-- eJF-c
Erosion Control
THIS APPLICANT IS:
1,k�R ❑CONTRACTOR
Park Fee
PROPERTY OWNER/
NAME: e® P
Sewer Main Charge
TENANTADDRESS:
/al— %� ! wee,. � eve ,r CITY
STAT1iM1,IP S�?e
$ 416, ®
PHONE:
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
9MINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION 49�GARAGFISHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
aNEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: bycf.j S " d
SIZE OF IMPROVEMENT /Y LENGTH / Z-- WIDTH I Z
HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
S
❑ ATTACHED GARAGE
1.
2•
Existing Floor Plan
Proposed floor plan
PROPOSED SIZE: 1
1104 ❑ 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.
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
3.
Energy Calculations
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:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 1600 00 OCCUPANCY TYPE
Permit Fee
$ See Back Page for Fee Schedule
Plan Review
$ ,R
65% of Building Permit Fee
Surcharge
$
(.0005) times the total job valuation — Minimum $.50
Fire Surcharge
$
001 x Permit Valuation (1/10%)
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $20 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$ 416, ®
Make 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 des of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for permit and work is not to start without a pe it; that the work will be in accordance with the approved
plan in the case of all work wh' equires re 'ew and approval of plans.
SIGNATURE OF APPLICANT RINT N ��i / �°�r� DATE ��� �! S'
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 V $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' $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
$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, MN 55432
763-572-3604
Fax: 763-502-4977
08/30/2005 13:24 6514388611
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PAGE 02
to
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City of Fridley Building Inspections Dept.
6431. University Ave NE
Fridley MN 55432
Mechanical
Ph: 763-572-3604 FAX: 763-571-1287
Residential Application
City of Fridley
See Back Side For Required Information
Permit # ' 5 06�--O/ ql-�2
Date Site Address:
/d �_ %Q /-"6cj5'
The applicant is: (cirl a one)
ner.Contractor
Property Owner: ori Se ve(s,
Address: 101-
0sCity:
City:'j N t
State: cn v Zip: r'rY 3 Z
Phone:/yY Cell:
76 3 - Fax:
Contractor Information
Company Name:
Contact Person:
Address:
City: State: Zip:
Phone: Cell:
Fax:
Email:
MN Bond# & Exp Date
Type of Work (circle one): New
Replacement Alteration/Remodel
Detailed Description of work:
5 /• we -ha J,/4e e fl
Equipment Installed: MFG:
Model: Size/BTU:
MFG:
Model: Size/BTU:
MFG:
Model: Size/BTU:
Please check all that apply: _Fireplace
(gas) $15.00 New Gas Grill $10.00
_A/C $25.00 _Fireplace
(wood) $35.00 _Gas Unit HTR $10.00
_Air to Air exchanger $15.00 _Furnace
$35.00 _Pool Heater $35.00
_Boiler $35.00 _Gas
Dryer $10.00 _Ventilator $15.00
_Chimney Liner $10.00 _KGas Piping $10.00
Duct Work $10.00
Gas Range/Oven $10.00
Permit Fee $ �
0
0(Total from above -Minimum fee $35.00)
Surcharge
0.50
Total Due $ 3 ' 6 Make check payable to City of Fridley
This is an application for a permit- not valid until processed
I hereby apply for a mechanical 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 mase of all work which requires review and approval of plans.
Signature of Appli
Approval Inspector Sig
Date:
Date:
Please Note: Separate permits are required for Building, Plumbing, and Electrical work
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMESIADDITIONS ❑EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas 1MC 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 Energy Code 7670 or 7672
6. Duct Design. Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make up air calculations
Llv� fCual/Suh
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