PRE 2010 DOCS6, s
Cary of Fridley, Minn. N° 8459
t`
BUILDING PERMIT
Date: _September 15. 1965
Owner: Bir Homedale ..Builders
Address 7539 Twpo Terrace. N.E. Adder .3 17 Lyn ale Avenue__sout
LOCATION OF BUILDING
No. 7539 Street TeMn Terrace N _F _ Part of Lot
Lot 7 _ Block 4 Addition or Sub -Division .M.1odyMa car - 4t'b Addi fid nn
Corner Lot _ Inside Lot X . Setback 35' Sideyard
Sewer Elevation Foundation Elevation
To be Used as:
Dwelling Front 40' _ Depth 243 Height 20_ sq. Ft. 1.032 Cu. Ft. 20,64
.1j, lux�. Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Frame Est. Cost _ $16, 000,0To be completed -65
In consideration of the issuance to me of a permit to construct the building described above I agree to do
the proposed work in accordance with the description above set f th and in c�mi an provisions of
of dinancos of the city of Fridley. O //
In consideration of the payment of a fee of $_23 - 0 , permit is hereby granted to HamP�P Bl cirs
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 ardini location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and in, permit may be revoked at any time upon violation of any of the protons of said
ordinances.
NOTICE
This pem* does not cover the construction, on for whin®, plumbing, ass heating, newer or water. Be sure to we
6e Bwmins hapecter for separate pwmBa for these flame.
OWNER'S
ADDRESS
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
LOCATION OF BUILDING
Street Part of Lot
...�,,....r
LRLOCK ADDITION OR S IV"ISION
Corner Lot Inside LOT P- Setback17
Side -Yard
SEWER MEVATION. F(?MATION ELEVATION.
^-
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as:.
Pp
Front If
,9 Dept -1y. � Height
Sq. Ft. Cu. Ft.�/�
Front Depth Height
Sq. Ft. Cu. Ft.
Type of construction � � Estimated Cost
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.
HA C6 SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
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 therefore, require the payment by the applicant for
such permit -of fees to -the amount herein below set forth and in the. -manner' hereim-
provided to -wit;
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'aay such permit for the erection of any fire -proof garage,
wsrehouse, 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 $1.25 for each one thousand cubic feet,, classified As "fireproof" by
Section 502 of the Minieapolis 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 ($0.90) for each one thousand cubic feet
or fraction thereof, in the cubical contents thereof with the 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.
22.5. 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.
2.6, In no case -shall the. fee charged for any permit as set fortin
Section 2 be less than $4.000
City of Fridley, 31inn. N9 9478
BUILDING PERMIT
Date: — Sept. 29, 1967
Owner: _ James Jablonski Builder Same
Address 39 Tempo Terrace Address
LOCATION OF BUILDING
No. 7539 Street _ Tempo ____ Part of Lot
Lot 7 Block 4 Addition or Sub -Division .—Melody Manor 4th Addn .
Corner Lot --- Inside Lot Setback Sideyard
Sewer Elevation _ Foundation Elevation _.
DESCRIPTION OF BUILDING
To be Used as:
Garage Front 23 � Depth 24' Height 10' Sq. Ft 552 Cu. pt, 5520
Front Depth . _ Height ._ Sq. Ft. Cu. Ft.
Type of Construction Frame Est Cost T $B% 1300 To be Completed
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description abov t forth gnd in compliance with all provisions of
ordinances of the city of Fridley. �\
In consideration of the payment of a fee of $ 8.00 , permit is hereby granted to James Jablonski
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 violation of any of the provisions of said
ordinances.
CL/ARENCE BELISLE Building Ingpectm
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be erre to an
the Building inspector for separate permits for these items.
r:.., j�' .. rte.. t, C .� A
l .t �. Ci'` 1'a\�.1�:_,.:. �, T'1!'L`�a:�'ai l��'t"i
OI1`iER'S NAi1:;
_��tw
ADDRESS
2,LOCATION 01-W BU:1 DI'L C
.'---.—STREET C° {Y PART OF LOT Sr01te_ CrV- 6
I,C)x'•-�"-" p$LOCJi ATJDT'1'J C)N OR SUEiJ)' V 1 SJ:ONj-----Y��% (r
� o
4 --
CORNER LOT INSIDE LOT ,.SES`BACY..__p � �� / d _SIDE-YMR,D
SEWER ELEVATION
FOUNDATION ELEV1W1ON
Applicant attach to this form Two Certificates of'Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be used Ad: - -.
�- Front_2
Depth__ E_4_ Height
Sq. Ft..�J�� Gu. Ft.
- _ _--- -- -- Front - - Depth Height -
Sq. Ft. Cu. Ft
Type of Construction r i _ Estimated Cost / Q
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 6 SIGITATURE
(Schedule of Fee Costs can be found on the Reverse Side
00
/ F f
G
SUBJECT
PER
City ®f Fraley
5.51
AT THE TOP OF THE TWINS
g U I L D I N G P E R M I T
_ .6
r
CEIPT
• __ COMMUNITY DEVELOPMENT DIV.
SEC.
L✓ PROTECTIVE INSPECTION
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
11/15/79
JOB ADDRESS 7539 Tempo Terrace NE..
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
7
4
1 Melody Manor 4th SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
William Forster 7539 Tempo Terrace N.E. 55432 784-8360
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
C. Ted Olsen 574-1530
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
IX NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Free standing fire place
9 CHANGE OF USE FROM TO
STIPULATIONS
Install cumbustion air on existing furnace.
o
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
fireplace
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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 COMPLIED1
200 00
60
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
s •
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
15.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$15.60
—' GNATURE OF COd� ACTO OR AUTHORIZED AGENT tDATEt
WHEN ROPERLY
V LI T D IS IS YOUR PERMIT
SIGNATURE OF OWNERIIF OWNER BUILDERI ID,
DATE
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(New, Alterations, Additions, or Repairs)
OWNER: r w r" ;z pt' 11(2_ � n /e "UI LDER :
ADDRESS: �� %�G��.P r� %�°' ADDRESS:
TEL NO: � � / � �' �' 6 � TEL NO: � ��/,✓ `/ �'�:��
STREET NO: -7_6 � 2 STREET:
LOT:
Construction Location
BLOCK: ADDITION:
rl
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.
DE,SSCRIPTION OF CONSTRUCTION
Square Feet: /RC1 ei Cubic Feet:
Front:
Square -Feet:
Type of Construction:
To Be Completed:
Height:
Depth: Height:
Cubic Feet:
Estimated Cost: $�
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE: ��� SIGNATURE: --
C,
Stipulations:
�-j
aA4A;;F"� 9CA-V�� '
BUILDING PERMIT FEE SCHEDULE -
SECTION 2. The 7nr,pector of Buildings shall, before issuing permits for the erection
of any building or structure, or for any addition to any existing building or structure,
6r 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:
NEW CONSTRUCTION: Single Family IIomes and Garages: $4.00/1,000 cubic feet.
PLAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSION: (Concrete,Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x $15.75
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 $17.85
ADDITIONAL I NFORMAT I 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 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 ,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 $7.50 plus $.50 state surcharge.
VERIFICATION OF FOUNDATION
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
u
constrction 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.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made 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.
Lt
CITY OF FRIDLEY INSPECTION DIV. Effective On August 1, 1995
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, =*i:7375�
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
State Surcharge
TOTAL FEEa 2i
$$.50
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Burner Trade Name Size No.
BTU- HP EDR
No. ' -7,6, o -L
Rough–In Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
a
JOB ADDRESS
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work herein
Residential
Rate
TOTAL
specified agreeing to do all work in strict accordance with the City Codes and
Furnace Shell and Duct Work, Burner –
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace
$ 30.00
$
representations stated In this application True and correct.
(Side Vent – Fill Out Back)
107 ,1995
Gas Piping (Needed with new furnace)
$ 10.00
$Ll
OWNER _ ",2',v7c, 4::�
Gas Range
$10.00
$
.:
BUILDING USED AS
Gas Dryer
$10.00
$
ESTIMATED COST PERMIT NO.
*Air
Conditioning – All Sizes
$ 25.00
$
DgSCRIPTION qF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK
I% of Value of Appliance or Work
$
No. of Heatingkits—i—Circle One (Steam) (Hot Water) (Warm Ai
Trade Nam�i k -N Size No. U
Commercial/Industrial
BTU 40 J= HP EDR
1.25% of Value of Appliance or Work
$
Fuel.Q:3 is Total Connected Load
State Surcharge
TOTAL FEEa 2i
$$.50
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Burner Trade Name Size No.
BTU- HP EDR
No. ' -7,6, o -L
Rough–In Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
a
All other BTU's
TOTAL BTU's,
7. Has a liner been provided for water heater Yes () No ( )
8. Has combustion air been provided for water heater Yes () No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
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
O No ( )
4.
Is securely supported
Yes ()
No ( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes ()
No ( )
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's,
7. Has a liner been provided for water heater Yes () No ( )
8. Has combustion air been provided for water heater Yes () No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
9
SUBJECT
City ®f Fridley
26 9
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
-RECEfIfT NO.
� art: ----- _ COMMUNITY DEVELOPMENT DIV.
ey�
!✓�
r PROTECTIVE INSPECTION SEC.
1 . �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
a''
612-571-3450
910-F15
8/5/98
JOB ADDRESS
7539 Tem o Terrace
1 LEGAL
LOT NO.
BLOCK7ACT
OR ADDITION
SEE ATTACHED
DESCR.
7
4Melody
Manor 4th Addn.
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Bill Foster
784-8360
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
La France Exteriors 342 McKinley t Anoka 55303
712-109020081887
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 M REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (25 S) Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with State Building
Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECYRICAL, 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. OWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
2085
$1.04
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 O THE P RFO ANCE OF CONSTRUCTION.
7/{.75
Fire SC $2.09
i-
a", - j ._
PLAN CHECK FEE
Lic e C
$5.g6
FEE
TO78L2.88
SIGNA RE CONTRACTOR OR AUTHORIZED AGENT IDA EI
HE PROP
VALID T THIS IS Y UR PER
B G INSP
GATE
SIGNATURE OF OWNER pF OWNER BUILDER] IDATEI
9
NEW [ l
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Owner Name & Address:
Contractor:
Address:
Effective 1/1/98
Tel. # %ZZ S-6-0
MN LICENSE # 1-7L������
SY303 Tel. # �,, -�®gam
Attach to thy' 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: Width Hgt/Gro7!27-
Sq. Ft.
OTHER: �� �z e. S �? a 13 C, e A
Construction Type: Estimated Cost: $ os-: -
(Fee Schedule, on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT: �' "' ���' Tele # 7/,
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
s
$
Fee Schedule on Reverse Side
$
.001 of Permit Valuation (1 / 10th %)
$
$.50/$1,000 Valuation
$
$1000 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 [ ]
r
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 buildkig or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the aakou'lit
herein below set forth and in the manner herein provided to -wit:
TOTAL VALUE FEES
$1 to $500 $21 (Minimum Fee is $21 plus surcharge)
$501 to $2,000 $21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$2,001 to $25,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$100,001 to $500,000 $887.25 for first $100,030 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for constriction 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.
'n
NEW []
ADDN []
ALTER [ ]
XConstruction Ad
Legal Descriptio
XOwner Name &
Contractor.
CITY OF FRIDLEY Effective 4/1/2004
6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION Q
MN LICENSE #
Address: Tel. #
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
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
ut
Construction Type: Estimated Cost: $
Driveway Curb Cut Width Needed IS Ft + 6 Ft = Ft x $ 0 f =$
DATE: APPLICANT: Tel. #
Call (763) 572 04 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
TOTAL
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 [ ]
$ yp®� 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
Engineering
WATER AND SEWER
Permit No.
763-572-3552
PERMIT APPLICATION
Received By:.
763-571-1287 fax
CITY OF FRIDLEY���
EFFECTIVE
D
1/1/2010
APPLICATION DATE:' vl- L YOUR E-MAIL/FAX:
THIS APPLICANT IS: 0 OWNER �d CONTRACTOR
JOB ADDRESS: -ZS7'lrI 12 ,,,,. p o Tc, / k ee
NEW CONSTRUCTION PERMIT# (IF APPLICABLE):
PROPERTY
NAME:
OWNER/
TENANT
/
ADDRESS:__ -7'3y Je .�o D ?/✓air W�h y `rl�t STATE ZIP
PHONE: %Ce3'
CONTRACTOR NAME:
SUBMITA'COPY OF DRESS: i(r� ��TH
YOUR STATEp STATE01A)ZIP
LICENSE WITH PHONE (Q - SIci- `3'q c, --7
CELLPHONE: 7(,,1
APPLICATION -
STATE LIC # STATE BOND: EXP DATE:
1. Narrati / description:
(written
7'�t,L+/� � � �? CO ✓1 d1 � G+`'� 9�2 � C.� � L r..v.l � `� Y ' dL/1
2. Please attach sketch showing curb line, utility line, building, etc. with distances on back page.
3. Stipulations:
PERMIT TYPE
❑. SEWER CONNECTION PERMIT $50
❑ WATER CONNECTION PERMIT $50
❑ WATERLINE REPAIR $40
❑ SEWER LINE REPAIR $40
❑ ADD STATE SURCHARGE $.50 160
❑ SAC CHARGE @ $2100 =-7qW
q-6
TOTAL $
OTHER CHARGES (IF APPLICABLE) PAY TO UTILITY BILLING
NEW WATER METER COST — SEE UTILITY BILLING
SPECIAL' ASSESSMENTS — SEE FINANCE
WATER TAP — SEE ENGINEERING
NOTE: WATER METER REPAIR, INSP OR SHUT-OFF / EVENINGS, WEEKENDS & HOLIDAYS $125/HOUR-BILLED
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a water or sewer (new connection or repair) 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. I understand this is not a permit but
only an application for a pe d woy/is not to start without a permit. /
�`�'^e I �G•
SIGNATURE OF APPLICANT V�^ PRINT NAME: W f l DATE: e-1-1V-10
APPROVED BY. DAA; -Pt _ /O
COPY GIVEN TO: KUTILITY 1141,41G (only if new meter) ❑ PUBLIC WORKS ❑ ENGINEERING
uIry of rridiey
Engineering Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3552
FAX: 763-571-1287
c`�
I