PRE 02010 DOCSSUBJECT
P N
City of Fridley
®14191
AT THE TOP OF THE TWINS
PERMIT
BUILDING
RE
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
1 �
{ CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
�---- �`� 612-560-3450
910-F15
6/30/77
JOB ADDRESS 5085 Topper Lane N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
23
5
Carlson`s Summit Manor South
SHEET
2 PROPERTYOWNER MAIL ADDRESS
ZIP
PHONE
Phyllis Hangerford 5085 Topper Lane N.E.
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
Panelcraft 3615 East Lake Street
721-6628
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
X
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Cover trim with aluminum
9 CHANGE OF USE FROM TO
STIPULATIONS
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
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.
$2, SOO
$1
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
.25
DOES<NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVIS ONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$15'00
TRUCTON OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$16.25
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
- EPYOPERLY VALIDATED THIS ISYOUR PERMIT
BLDG INSP
DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER: ��s� ,`�L�,��,�,� 13UILDER: `
Address: �_i ���� L d'f�E Address:
Tel. No .
No.: ® �� Street:
rVM
LOT: ��
BLOCK:
15-
ADDITION:/�S�
)'S' .'�(�/1�/17/l
ll �1w41 &e,
CORNER LOT:
INSIDE
LOT:
SETBACK:
SIDEYARDS:
Ua
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
0
To Be Used As:
DESCRIPTION OF BUILDING
Front: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: • Height:
Square Feet: Cubic Feet:
Type of Construction: �� p y /�,6^ Estimated Cost: $,,-,, DL>
To Be Completed: 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. See reverse s(de or additional information.
DATE: SIGNATURE
Stipulations:
BUILDING PERMIT FEE SCHEDULE
SECTION 2: The Inspector. of Buildings :hall, 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 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 Homes and Garages: $4.00/1,000 cubic feet..
PIA24 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 $11.75
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 $15.40
ADDITIONAL INFORMATION
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 oC 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 mor 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 th:_:e`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.
SUBJECT
P R
City of FridleyPI+
9 7637'
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
�
RECEIPT
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
�
l1 {
`•� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
--_� A ��""
612-571-3450
910-F15
8/1/84
JOB ADDRESS 5085 Topper Lane N.E.
1 LEGAL
LOT NO.
BLOCKTRACTOR
ADDITION SEE ATTACHED
DESCR.
23
5
Carlson's Summit Manor South. Addn. SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Phyllis Hungerford 5085 Topper Lane N.E. 572-8713
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Panelcraft Inc. 2308 Snelling South, Mpls., MN 721-6628
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 0 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Construct a 12' x 16' Deck & add Patio Door
9 CHANGE OF USE FROM TO
STIPULATIONS
WARNING
Before digging calf local utiiitieg
SEPERATE PERMIT'S RE f-D fOR WIRIft TELEPHONE - ELECTRIC - GAS Etc.
HEATING, PLUMBING Af40 SfQN$6 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,100
$.55
DOES NOT PRESUME TO GIVE A THORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHE OR LO AL LAW REGULATING CON-
TION OR THE P RF a OF STRUCTION.
$19.00
LAN CHECK FEE
TOTALFEE
4.75
$24.30
WHEN PROPERLY A IDATED HIS IS YOUR PERMIT
SIGN O CONTRACTOR OR AUTHORIZED AGENT IDATEI
s % l
BLDG INSP aTE
SIGNATURE OF OWNER IIF OWNER BUILDEM (DATE)
NEW [ ]
ADDN. [ ]
ALTER. [ ]
Construction Addri
Legal Description
Owner Name & A
Contractor:
Address:
City of Fridley
�R-1 AND R-2
Building Permit Application
Effective 4/1/84
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:
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback
Type of Construction: �% 7/n Y Estimated Cost: $ C
/od
Approx. Completion Date: �5t
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
A Z
DATE: APPLICANT:
Tel.
TY USE ONLY
Permit Fee $ ' /�_ Fee Schedule on Reverse Side
Plan Check $ 25% of Building Permit Fee
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $425 per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ 9L -W
STIPULATIONS•
N - -
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 Valuation Fees '
$1.00 to $500.00 $10.00 (Minimum Fee is $15.00)
$501.00 to $29000.00
$10.00 for the first
$500 plus $1.50 for
each
additional $100 or fraction thereof, to and including
$2,000.
$2,001.00 to $25,000.00
$32.50 for the first $2,000 plus $6.00 for
each
additional $1,000 or
fraction thereof, to
and
including $25,000.
$25,001.00 to $50,000.00
$170.50 for the first
$25,000 plus $4.50 for
each
additional $1,000 or
fraction thereof, to
and
including $50,000.
$50,001.00 to $100,000.00
$283.00 for the first
$50,000 plus $3.00 for
each
additional $1,000 or
fraction thereof, to
and
including $100,000.
$100,001.00 and up $433.00 for the first $100,000 plus $2.50 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 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.
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CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
►63) 572-3604 FAX: (763) 571-1287
ADDRESS : 5085 TOPPER IN NE
PIN : 263024230101
LEGAL DESC : CARLSONS SUMMIT MAN SO ADD
: LOT 23 BLOCK 5
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION : $ 2,250.00
NOTE: REMOVE AND REPLACE GARAGE ROOF TRUSSES AND ROOFING.
PERMIT NO.: 2004-00766
DATE ISSUED: 05/24/2004
APPLICANT BUILDING PERMIT FEE
BARTLETT JODY A FIRE SURCHARGE
5085 TOPPER LN NE STATE SURCHARGE, VALUE
FRIDLEY, MN 55421 TOTAL
OWNER
BARTLETT JODY A
5085 TOPPER LN NE
FRIDLEY, MN 55421
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 worl
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the rovisions of any other state or local law
regu ating truc7on or the performance of construction.
Bldg Insp.
TE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
83.25
2.25
1.12
86.62
NEW []
ADDN j ]
ALTER [ ]
Construction Address: <_(A`7'
CITY OF FRIDLEY
6431 University Ave NE, Fridley, MN 55432
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
C;00 Ll
4 W - /40 (el
/
* fFe,.fve 4/1/2004
(763) 572-3604 Bldg Insp
(763) 571-1287 Fax
Legal Description: -' O I
Owner Name & Address:\Tel.
Contractor. 4 rj5�PhPfbadDlnvn MN LICENSE#
Address: Crate 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:
e'
Construction Type:
Estimated Cost: $
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x
DATE: '
Z- APPLICANT: Tel. #,%P�
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 N using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
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 [ ]
TOTAL $ No, �� 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
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SUBJECT
City of Fridley
173330
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
':
r :y _ PROTECTIVE INSPECTION SEC.
tlj�a
1 �
REV
DATE
PAGE OF
APPROVED BY
= CITY HALL FRIDLEY 55432
763-571-3450
=UMBER
8/28/03
JOB ADDRESS 5085 Topper Lane NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
23
5
Carlson's Summit Manor South Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jody Bartlett 5085 Topper Lane NE
763-572-0583
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Same
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
a
❑ NEW ❑ ADDITION X ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install basement egress window to meet State Building Code
9 CHANGE OF USE FROM TO
STIPULATIONS
Permit issued subject to submitting sketch and getting the plan review
completed.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO DWLG. UNITS
OFFSTREET PARKING
1
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
$900
$
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
.50
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-
$.90
STRUCTION$35.70
OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
$37.10
ATURE OF CON" CTORORAUTHOR1ZEO AGENT tDATRTE
WHEN PROPE
Y VALIDATED THIS IS Y UR PE MIT
lJ
Q
AA N
R NE iiF OWNER BU�I DERE DAT
BLD iNSo
F!A IV,
NEW [ ] CITY OF FRIDLEY
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION '
Construction Address: -'T�� ►� L.Q hg.
Effective 1/1/2003
(763) 572-3604 Bldg Insp
(763) 571-1287 Fax
9
F1S" WovCsi
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: �1S-fciL1 hQ�P 1't'1 _nt r-05 W I I pLo - T() f
Construction Type: EorzssUYl OW Estimated Cost: $®®
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: a g 3 APPLICANT. PTel. #2/0
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.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ 96 Fee Schedule on Reverse Side
$ 90 .001 of Permit Valuation (1/10th%)
$ . S`7� $.50/$1,000 Valuation
$ $1275 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 [ ]
$ ':�%'/®
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
$501 to $2,000 $23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$2,001 to $25,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$25,001 to $50,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$50,001 to $100,000 $643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$100,001 to $500,000 $993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $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
$1,000,001 and up $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 a of the existing foundation will be required before
proceeding with the framing. New Houses Only
Building MECHANICAL Permit No,!
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date%M: V 20
DATE YOUR E-MAIL ADDRESS
C—
SITE ADDRESS J '� • if
THIS APPLICANT IS: R *ONTRACTOR
PROPERTY
NAME: SEVIE 1'+ ffatc
OWNER/
1
ADDRESS: Sc — L CITY f eSTATE ZIP
`'
TENANT
PHONE:
CONTRACTOR
COMPANYNAME: Sharp Heating & A.C.
SUBMIT COPY OF
CONTACTPERSON: Floyd Joswick
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE WITH
ADDS: 7221 University Ave. N. E. CITY Fridley STATE MNZIp 55432
APPLICATION
PHONE 763-572-0459 FAX
PERAM TYPE
�(SINGLE FAMILY Q TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
11 NEW REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK
PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $50.0.00; whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FE ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERENOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
Equipment Installed MFG: (�,JJ MODEL: V SIZEBTU. 70, of
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
_A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
_AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_BOILER $35.00 7e FURNACE $35.00 GAS UNIT HTR$10.00
_CHIMNEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER $35.00
_DUCT WORK $10.00 ZGAS PIPING $10.00 VENTMATOR $15.00
Permit Fee $ Number of fixtures @$10.00 x$10.00=$ Idain
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $3.S'• Od
State Surcharge = $ 50
Total = $ 57
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 atjon for a permit and work is t to start without a permit; chat the work will be in accordance with the
approved plan in the case ork w i re s review a royal of LpplaTns. Q
SIGNATURE OF APPLICANT PRINT NAME o DATE I Q U
401 City of
Fridley
��.��,.��.��w„�.«w�,.,,,�.��-.,s.�-�ca�,w:wvru�ra �,bv�xi�mse�,�•�i�fs�l�a,.ti,�xi�a'�"`�:,.�n;�
Building Inspections Department
1 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
3uilding
BUILDING
Permit No.:
Enspections
RESIDENTIAL APPLICATION
Received By:
'763-572-3604
Date REGO 07 20
CITY OF FRIDLEY
)ATE "5 v I YOUR E-MAIL ADDRESS ,i
o C.( l S CDL It L r,� ofy S_ f O >�
>ITE ADDRESS 5 6$
�
O Q D I i d %� Q U
iHIS APPLICANT IS:
❑ OWNER )KlCONTRACTOR
PROPERTY OWNER/
NAME: ¢ vn Vg
TENANT
ADDRESS: S 0 $ O u 0I t^ %i CITY r/ c! l c v STATE ZIP 'S Sq
PHONE: -7 L 31 S -14 - L1 1 C7
CONTRACTOR
NAME:_ 17HD At- Home Services, Inc.
Jpdt B) cuff J004
STATE LIC 2690 Cumberland Pkwy, Ste 300
q S ,'t t 3 �!5 - (, 0 L! j
SUBMIT A COPY OF
Cumberland Office Park
YOUR STATE LICENSE
ADDRESS
CITY STATE ZIP
WITH APPLICATION
PHONE Atlanta, GA 30339-3913
SINGLE Lic# 20268257 Ph. 763/542-8826
'.E
PROPERTY TYPE
❑ TWO FA
.ORIES
PERMIT TYPE
QADDITION ❑ GARAGE/SHED
W]NDOWS
❑ BASEMENT FINISH ❑ ROOF
❑ DRAIN TILE
❑ DECK ❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
N MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: lv I'I do j J pfp M,
t -Al Ad D
>IZE OF IMPROVEMENT LENGTH
WIDTH HEI HT Sq. Ft.
tOOFING
❑ HOUSE ONLY
KIMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
TARAGES
❑ATTACKED GARAGE
1. Existing Floor Plan
2. Proposed floor plan
ROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
'ROPOSED HEIGHT:
.IDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
I Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
I Aluminum
❑ Trim
1. Site Plan/Survey showing the existing structures
I Other
❑ Fascia
and proposed project
F'INDOWS
2. Two sets of construction plans
Y FOR NEW
OPENINGS 15YDES ❑3E LOCATION OF+WI/NDO�J'S, l`'�
)R FOR NEW OPENINGS -DESCRIBE SIZE OF V/ ll I /1 7 5? ay`'�j
t Jrw
(3(
3. Energy Calculations
TENING CHANGES &
YPE 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 $ 3 -77 1, OCCUPANCY TYPE
ermit Fee $ R -7. 3 '5— See Back Page for Fee Schedule
Ian Review $ 65% of Building Permit Fee
urcharge $ M (.0005) times the total job valuation — Minimum $.50
ire Surcharge $ ,? Z $ .001 x Permit Valuation (1/10%)
icense Surcharge $ -00 $5.00 (State Licensed Residential Contractors)
AC Charge $ $1450 per SAC Unit (Plans to MWCC for determination)
:urb Cut Escrow $ ft + 6 ft = ft x $20 = $
rosion Control $ $450 Conservation Plan Review
ark Fee $ Fee Determined by Engineering
ewer Main Charge $ Agreement necessary ( ) Non Necessary ( )
'otal Due $ / p 7 _ e% Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
mformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
-rmit but only an application for a permit and k is not to start without a permit; that the work will be in accordance with the approved
[an in the case of all work which re/quires r 'e d. approval of plans. �
GNATURE OF APPLICANT -� PRINT NAME ` ` (in M � S ( A va DATE /� � � v �_
I.
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 $23.5.0 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
$39125 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 1s` $500,000 plus $4.75 for each additional $1,000 or
fraction to and including $1,000,000
$1,000,001 and up
$5,608.75 for the 16'$ 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