PRE 2010 DOCSLOCATION OF BUILDING
No. o Street P of Lot
Lot _ ___ Block Addition or Sub -Division .
Corner Lot _ Inside Lot _ Setback Sideyard �r
Sewer Elevation c9 70- -1
awe o�r�e•a-�N�
DESCRIPTION OF BUILDING
In consideration of the issuance to me of a permit to constru buildiFltj
Wed above I agree to do
the proposed work in accordance with the description above se o andel in ance with a'll provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ , permit is hereby granted to...._
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon vio,"n of any of the provisions of said
ordinances. 0"-% A A / I
NOTICE:
•This permit doer not ewer the construction, Installation for wiring, plumbing, gar heating, sower or water. Be sure to we
the Building lnsimWer for separate peraft for than hone.
APPLICATION FOR BUILDING PERIIT
CITY OF FRIDLEY, MINNESOTA
Owner I s Name .� Builder
CLEMRON, INC°
Address Address 3619 Benjamin St. M. 6,.
Mimi.Minne3p0th, to,
LOCATION OF BUILDING
No. Street Part of Lot
Lot Block �� Addition or Subdivision
Corner Lot Inside Lot ��' Setback Side -Yard le e
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
Front,42.-g:2 j
rn Sq. Ft. z� ;t�9 Cu. Ft.
-401
N. _ .
To be Completed
Sq. Ft. 41000 e Cu. Ft.
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and rept s, tations
stated in this applic ion ar�true and correct. � �
CrI kr,— SIGNAT.a,r
(A Schedule of Fee Costs can be found on the Reverse Side.)
BUILDING PERMIT FEE SCHEDULE
Section 2., The Inspector of Buildings shall, before issuing any permit for the
erection of any building or structure, or for any addition to any existing build-
ing or structure, or for any alterations or repairs to any existing building or,
structure, upon application therefor, require the payment by the applicant for
such permit of fees to the amount herein below set forth and in the mnner herein
provided to -wits
2.1. For any such permit for the.erection of any fire -proof building, other than
a garage, warehouse, factory or grain elevator, or for the erection of any fire-
proof addition, for similar occupancy, to any existing building shall be at the
rate of $1.40 for each one thousand cubic feet, or fraction thereof, in such
cubical. contents.
2.2. For any such permit for the erection of any fireproof garage, warehouse,
factory or grain elevator, 'or for the erection of any fireproof addition, for
similar occupancy, to any existing building shall be at the rate of $1.25 for
each one thousand cubic feet, classified as "fireproof" by Section 502 of the
Minneapolis Building Code.
HOUSES
2.3. For any such permit for the erection of any non -fireproof building other
than a garage, warehouse, factory or grain elevator, or any non -fireproof
addition, for similar occupancy, to any existing building. Permit $1.00 for.
each one thousand cubic feet.
GARAGES
2.4. For any such permit for the erection of any non -fireproof garage, warehouse,
factory or grain elevator, or for the erection of any non -fireproof addition, for
similar occupancy, to any existing building or for each such building or addition.
Ninety Cents for each one thousand cubic feet or fraction thereof, in the cubical
contents thereof with a minimum of $4.00.
For the purpose of computing fees for building permits the cubical `contents of any
building or 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 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.
2.5. For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 for each Five Hundred Dollars ($500.00), or fraction thereof in the
cost of all proposed work.
2.6. In no case shall the fee charged for any permit as set forth in Section 2.be
less than $4.00.
D,
SUBJECT
City of Fridley
20114
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RE
',,
• COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
33 I /
1 { 1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
9/18/89
JOB ADDRESS 7360 Tempo Terrace N.E.
1 LEGAL
LOT NO,
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
7
3
Melody Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Bill Tozer 7360 Tempo TerraceN.E.
784-6263
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
AMRE 3700 Annapolis Lane, Plymouth., MN 55447
553-0020
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 Ij REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reside Dwelling
9 CHANGEOFUSEFROM TO
STIPULATIONS
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
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
$2.95
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$5FqQ0L
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$81.00
PLAN CHECK FEE
TOTALFEE
$83.95
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPER JDATED THIS IS YOUR PERMIT
BLDG INSP
ATE
SIGNATURE OF OWNER uF OWNER BUILDERI IDATEI
D,
Prepaid Plan Check $ Effective 5/1/88
Estimated Cost QTY OF FRIDLEY
Receipt # R-3, C = & INXMTRIAL
Building Permit Application
TYPE OF WORK [] New [] Addition [] Alteration -Describe
Applicant signator �� - Tel A,06 ODate
9.��'
BIIILDING DIlMENSIC M
length Width Height Sq. Ft. # of Stories
OFC. AREA: Length
Width
Height Sq.
Ft.
WHSE AREA: Length
Width
Height Sq.
Ft.
MiE R AREA: Length
Width
Height Sq.
Ft.
VALMMCK
Sq. Ft. x $
Cost/Sq.
Ft. = Valuation $ )
Sq. Ft. x $
Cost/Sq.
Ft. = Valuation $
Sq. Ft. x $L—
Cost/Sq.
Ft. = Valuation $ •)
TOTAL VALUE
Building Use Cmistruction Type Oca4ancy Group
Air Conditioning []Yes []No Fire Protection Provided []Yes []No
Performance Bond Amount $ See Reverse for Schedule• Received []Yes []No
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
$ , � 00
Spec. Assessments $
Dr9
See Fee Schedule on Reverse Side
In Excess of Prepaid Amount - See Reverse Side
$.50/$1,000 Valuation (See SChed. for > $1 Million)
$575 per SAC Unit
Fee Determined By Engineering
Agreement Necessary [] Not Necessary []
feet x $13.50/foot
SFO U ►d
SUBJECTPE
City of Fridley
20133
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r?
RECEIPT NO.
•
Ly.......COMMUNITY DEVELOPMENT DIV.
-
r i � PROTECTIVE INSPECTION SEC.
1 • �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
j, 612-571-3450
910-F15
9/28/89
JOB ADDRESS 7360 Tempo Terrace N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
7
3
Melody Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Bill Tozer 7360 Tempo Terrace N.E.
784-6263
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Morris Roofing 601 - 22nd Avenue N.E., Minneapolis, MN 55418 781-7585
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 Ek REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Dwelling (22 Squares)
9 CHANGE OF USE FROM TO
STIPULATIONS
Roof can be the 2nd layer but not the 3rd.
Install ridged galvanized
valleys,
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
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
$l,lOO
$.55
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-
$27.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$27.55
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERLY
r
V [DATED THIS IS YOUR PERMIT
SIGNATURE OF OWNER OF OWNER BUILDER$ (DATEi
BLDG INSP
bATE
NEW [ ]
ADCN [ ]
ALTER [ ]
R-1 AND R-2
Building Permit Application
Effective 5/1/88
Construction mss : `7 E L O T e m Dol e r •r o- c e
legal Description: S, v124� e- F6\
Owner Name & Address: --�-o -z C r ZIet.
Contractor: P --An r r
CAKA c S leo r r d 5) Tel. # 7?1 - 7,<-75
Address: foo c ;a.) ,A A f� t -A et 5
Attach to this application, a Certificate of Survey of the
lot, with the proposed bion drawn on it to scale.
I : Is I TT of IInmeVEMM
LIVING AMM: length Width Height Sq. Ft.
GRRMM AREA: Length Width Height Sq. Ft.
DECK AMM: length Width Hgt/Crouxi Sq. Ft.
07HM: 'R, C A r- p r. � 7
Corner Lot Y[ ] Inside Int [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimated Cost: $
Approx. C mpletion Date: 11
Od
Proposed Driveway Width If New opening Is Desired: Ft. $ $
Width + 6' See Back Page
DATE: APPLICANT: Tel, #
QTY LAY
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$575 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Detemn ned by Et�gi T ri rr�
Agreevent Nay [ ] Not Necessary [ ]
110o
:•Ip of 0 11 f
The Chief Building Official shall, before issuing permits for the erection of any
building or structure, or for any addition to any existui 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 m WMr herein prwided to -wit:
$1 to $500
$15 (Minim= Fee is $15 plus surrharge)
$501 to $2,000
$15 for first $500 plus $2 for each additional $100 or
fraction thereof, to arra 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
EPZVEMY NESSICK 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.
Permits for construction will be issued a mini3nim of 24 hours from the time of
application to allow for proper review of the proposed structure and of the
ooaistruction 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.
CITYbF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Effective On January 1, 2002
JOB ADDRESS 60 Tnh0 5 z -:---
OWNER Cke®Z —1Z
TOTAL
BUILDING USED AS S (F�LLlA/C
$t.6
ESTIMATED COST PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units_ Circle One (Steam) (Hot Water) (Warm Air,
$ Trade Name G/Wjcu5�� Size No.
BTU HP EDR
$ Fuel Total Connected Load
Burner Trade Name Size No.
$ BTU HP EDR
$ 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 an
$ 50 rulings of the Building Division, and hereby declares that all the facts and
s�representations stated in this application are true and correct.
$ `70
SUPMOR COI '►CTC bel, IN07
61214 DAVEMENO. DATE
YE'TAL, MN 55422
HEATING C
Signed TEL #
FAX #
0
t
Approved By Rough -In Date Final Date �� ��
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
COMMON VFNT, VFNT CONNFr-TQR ANn COMMISTION AIR VERIFICATION
When re In_anina an existingf uri anre, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes '16
No( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No ( )
The existing rnmb ,c ion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No ( )
When required to install a new .omb scion airy it will be sized and installed
to meet the current codes and manufacturer's specifications. YesNo( }
When installing a new venting systam, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes () No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes( )No(
)
Appliance #1 Type
BTU Input
Fan Assisted or Nat
Appliance #2 Type
BTU Input
Fan Assisted or Nat
Appliance #3 Type
BTU Input
Fan Assisted or Nat
Total Appliances
Total Btu input
Common Vent Type
Vent Height
Diameter inches
Appliance #1 Vent Connector Height
ft Length
ft Diameter in Type
Appliance #2 Vent Connector Height
ft Length
ft Diameter in Type
Appliance #3 Vent Connector Height
ft Length
ft Diameter in Type
HEATING CO: MCT A4
AAN 654",
Signed By: ems— Date:
HOUSE HEATING TEST RECORD
ADDRESS G felx420 APT. FLOOR CITY SUBURB
OCCUPANT I 2 a-1 `' OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY 10-l`- INSTALLED BY
Electrical Work By Gas Line By
TYPE OF HEAT GA FA X_HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN
MAKE ����/'�✓ MAKE OF BURNER
Model Ike"- NI' # G 6 C> F,-_1 -/ 2L Model
Serial Z2 ?-w a 3 3 Max. BTU Rating —
INPUT ���,� r%l%� MAKE OF FURNACE
�i CONTROLS
THERMOSTAT Heat Plug
Valve Ole
Limit P/
Limit Setting oz v
Fan Setting
Pilot Type
Pilot Make 46,21,4/22
Pilot Model
CONVERSION
Model
�/f
Vent Size
KIND OF LINER SIZE NONE
Draft Hood Regulator
Filters Size /� l Number./
Chimney Location Insid�Jice—Outside
Chimney Construction
Smoke Bo Wiring
Pilot Timing / Draft Aa -Test Tap A
L.W. Cut Off Door Pressure Lighting Inst.
Pressure S Percent CO2 S Data Tested 13 4
Input CFH �d Percent 02 Company Testing
Stack Temp. Percent CO Name of Tester
Fong 235
1%
1
SUBJECT
..,
City of Fridley
33770
AT THE TOP OF THE TWINS
BUILDING PERMIT
g
�,�
------COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
�
r � PROTECTIVE
1 �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
= CITY HALL FRIDLEY 55432
763-571-3450
910-F15
8/6/03
JOB ADDRESS 7360 Tempo Terrace NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
7
3
Melody Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Carol & Wilbert Tozer 7360 Tempo Terrace NE
612-784-6263
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Grayhawk Builders 3020 Centerville Rd, Little Canada, MN 55117 651-486-9888
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
20174611
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace windows within existing openings
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the dwelling
per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all
exterior openings.
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 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 T I HAVE READ AND EXAMINED THIS APPLICATION
1 ISTALLS
GARAGES
AND KNOW TH E T BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDI CES GOV FINING THIS TYPE OF WORK WILL BE COMPLIED
WITH W THER SPECIF ED HEREIN OR NOT. THE GR NTING OF A PERMIT
$4,500
$2.25
DOES OT P SUME O GIVE AUTHORITY TO VIO TE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROV S]ON F ANY OTHER STA CAL L REGULATING CON-
$111.25
Fire SC $4.50
TI R TH PERFOR&IANCE OFC STR TION
PLAN CHECK FEE
TOTALFEE
SC $5.00
1 $123.00
SIGNATURE OFC A t AUTHOR AGE T iDATE. 1
H N PROPERLY VALIDATED
B D -NSP
THIS IS OUR P RMIT
0 TE
S-GNATuaE OF OW NER,iF OWNER BUILDER, -,DATE,
1%
1
f UG -06-2001 11.41 MON C I T'i' OF FP I r1LE,' TO
NEW [ J
ADDN j j CITY OF FRIDLEY
ALTER t j SINGLE FAMILY AND DUPLEXES P,.l AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name & Address:
Effective 1/1/2001
(763) 572-3M EMg Msp
Tel. # (V I --f89 ® (®3
MN LICENSE # Q 0 LQ I S
1 L3 Tef- # �`_5�� Cisco C(a a
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: Lenges Width Height _ Sq. Ft
DECK AREA: Length Width Hgt/Ground Sq. Ft-
OTHER.-
Construction
LOTHER;
Construction T e
YP- �, �Ii6 10ffOLUOWAA—Estirnated Cos'L ffi
L, , reway Curb Cut Width Needed: F + 6 Ft = __„Ft x $ = $
DATE: APPLICAN �e Tel.
CITY USE ONLY - Call (763) 572-36" for Per it Fees if nwiling in application
Permit Fee
o Fee Schedule on Reverse Side
Fire Surcharge
$ , -0
.001 of Permit Valuation (1/10th°/a)
State Surcharge
$
$.50/$1,000 Valdation
SAC Charge
$
$1150 per SAC Unit
License Surcharge
$___L- 6
$$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary j Not Necessary { ]
TOTAL
s 1e2..3
c- 'ILA -MONS:
Building
$
BUILDING
Permit No.:
Inspections
$
RESIDENTIAL APPLICATION
Received By
763-572-3604CITY
$
OF FRIDLEY
Date Rec'd:
DATE 10 - 16 �
YOUR E-MAIL ADDRESS
i, L4
SITE ADDRESS 23 60
/i�&t .
$
THIS APPLICANT IS:
❑ OWNER LNGONTRACTOR
SAC Charge
PROPERTY OWNER/
MAW: F, t( 1-a zzr-
$1550 per SAC Unit (Plans to MWCC for determination)
ADDRESS: CITY
STATE ZIP
TENANT
ft + 6 ft = ft x $21= $
PHONE: 76,3- % LtL — &a63
$
CONTRACTOR
NAME: /411 , A,ers
Park Fee
STATE LICENSE # 187X CCI i EXP DATE q-07
9,3G �' A-L-� Pt a t��� STATEIP-
aq
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: r CITY
L"
WITH APPLICATION
PHONE -Z & 3 i ®� -CL l Po FAX
ITSINGLE FAMILY/NEW CONSTRUCTION SIZE
Total Due
PROPERTY TYPE
0 TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE'
0 ADDITION ❑ ❑ WINDOWS
04RAGE/SHED
0 BASEMENT FINISH OF 0 DRAIN TILE
0 DECK 0 SIDING 0 OTHER
0 SWI MING POOL
TYPE OF WORK:
O NEW 0 ADDITION
®'AIAINTENANCE/REPAIR 0 REMODELING
DESCRIBE WORK BEING DONE: W_✓`c
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
R00MG 0 HOUSE ONLY
NUMBER OF SQUARES 0 HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
GARAGES
0 ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
0 DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
O Vinyl
OSoffit
ADDITIONS & PORCHES SUBMIT:
0 Aluminum
O Trim
I . Site Plan/Survey showing the existing structures
0 Other
0 Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN E)aSTING OPENINGS OYes ONo 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:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ �29 4 S. -- OCCUPANCY TYPE
Permit Fee
$
$3 a
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
-7.9
.001 times the total job valuation
Surcharge '
$
i, L4
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
5 .
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1550 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21= $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
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 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 worIA not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work whic equir s iew a approval of plans. s--,
SIGNATURE OF APPLICANT °� ° PRINT NAME 4 DATE W r�
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 I' $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- $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, MN 55432
763-572-3604
Fax: 763-5024977