PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N° 5868
Date:
Owner: 4-74 Builder
Address __ _M__ _ _ _ Address
�^►
L
QTI O BUILDING
No. _Sheet lte ° 'l _ Part
Lot _ . _ _ ___ Block Addition or Sub- ivision
Corner Lot --- Inside Lot Mbactr '`. _ ai deyard
Sewer Elevation __ _ _ Foundation Elevation
DESCRIPTION OF BUILDING
Tom t1 , as
p Sq. Ft.rf Cu. Ft. f r is
:= a Front Depth Height
_ Depth 'e, Leight Sq. Ft. _ Cu. Ft. _
Type of Constructiont `� Est. Cost _ _ _ _, 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 above set forth and in compliance with all 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, Mimlesota 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�ny of the provisions of said
ordinances. "1
'---;Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we
the Building Inspector for separate permits for these Items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner °s Name�Q 7-� Builder,
Address (, / Jl ��, YY ,-Address
LOCATION OF BUILDING
No. /� Stree P Part of Lot
Lot Block Addition or Subdivision
Corner Lot Inside Lot_,2.� _Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To be used as;
DESCRIPTION OF BUILDING
FrontDepth -2--,AHeight �-"-7
Sq. Ft. 2- % Cu. Ft. 2 -3
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost.
To be Completed G
MM
The undersigned heresy 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
61/
(Schedule of Fee Costs can be found on the Reverse Side).
. . — w . v .s
BUILDING PERFECT FEE SCI'.. UTAX
Section 2. The Inspector of Buildings shell, before issuing any permit for
the erection of any building o:: structure, or for any addition toany:exist-
ing building 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 manner here.:!n provided to—At!
2.1. For any such permit for the ere.tton of any fire -proof building, other
than a garage, warehouse, factor;; or grain eleirac:or, or for the erection of
any`fb-e-proof addition, for similar occupancy, to any existing building
shall be at the rote of $1,40 for eac'.1 one thousand cubic feet, or fraction
thereof, , in sveb cubical contentA .
2.2. For any such permit for the erection of any fire -proof garage, warehouse,
factory or grain'sle-vator, or for the erection of any fire -proof addition,
for similar occupancy, to any existing bvl Wng shall be at the rate of $1.25
for each one thousand cubic feet, classiiied as "fireproof09 by 'section 502 of
the Minneapolis Building Code.
HOUSES
2.3. For any such permit for the erection of any nor -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.
GARA,GPIS
2.4. For any such permit for. the erections of any non -fireproof 4varage,
warehouse, factory o_ 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) foi- each one thousand cubic feet
or fraction thereof, in the cubical contents thereof with a minimum of $4.00.
For the4purpose 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
baseman: or cellar to tha average height of the.uppar 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 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 forth in
Section 2 be less than $4.00.
F-0
SUBJECT
MIT NO.
City of Fridley
®�
AT THE TOP OF THE TWINS
BUILDING
PER T
` COMMUNITY DEVELOPMENT DIV.
v------
r PROTECTIVE INSPECTION SEC.
r
{ CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE Of
APPROVED BY
----�: �.j 612-571-3450
910-F15
9/8/99
JOB ADDRESS 6150 Trinity Drive NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
Pt. 5 6
2
Sylvan Hills Plat 2
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Steve Hillyard
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Owner
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 29X REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Re -roof house and garage (23__Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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
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
$2010
$1.01
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
$83,25
Fixe SC 2.01
%
PLAN CHECK FEE7$86.27
AL FEE
/I A '0011
4
_/
S1 *+0WE*OFCONTRA T a0 A TH EO AGENT iDATEt
XANATURE
HE PRO//
Y VA TED THITe_ UR�EQM
OF OWN dF OWNER BUILDER1 iDATEi
G
B DG SN50—PAYE
F-0
NEW [ ] ` Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 W
BUILDING PERMIT APPLICATION
Construction Address: %S'� , i-ln t
Legal Description:
Owner Name & Address: s ei-e. fly
y��.� Tel. #
Contractor: (Dw ✓1 e MN LICENSE #
Address: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EMPROVEMENT
LIVING AREA:
Length
Width Height
Sq. Ft.
GARAGE AREA:
Length
Width Height
Sq. Ft.
DECK AREA:
Length
Width Hgt/Ground
Sq. Ft.
OTHER:
t�
6'10 d
%`%S 2 €, e
2- 3 s9 ,
Construction Type:
zoj
Estimated Cost: $
$
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: / o APPLICANT: �G�� Tel. #
CITY USE ONLY
TOTAL
STIPULATIONS:
Permit Fee
$
C�3 c)� Fee Schedule on Reverse Side
Fire Surcharge
$
®% .001 of Permit Valuation (1/10th%)
State Surcharge
$
/, d j $.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC Unit
License Surcharge
$
$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 [ ] Not Necessary [ ]
TOTAL
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
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
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 $23.25.
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 it has been constructed will
be required before proceeding with the framing.
Building
BUILDING
Permit No. " tO 0
Inspections
RESIDENTIAL APPLICATION
Received By:,
763-572-3604
CITY OF FRIDLEY
Date R i J
763-502-4977 FAX
EFFECTIVE 1-1-2010
DATE
YOUR E-MAIL ADDRESS e - 6 a)D
c' Q co c
SrrE ADDRESS 416-0
THIS APPLICANT IS:
WNER ❑CONTRACTOR
PROPERTY OWNER/
NAME:e—v(e— Q d 14L�
TENANT
r�
ADDRESS: �� i n- b � CITY mit STATE II aoZIP
q�qlr
PHONE: 7(=x.3
CONTRACTOR
NAME:
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # EXP DATE
AND CERTIFICATE OF
ADDRESS:
CITY STATE ZEP
INSURANCE
PHONE FAX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN
TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR JRREMODELING
DESCRIBE WORK BEING DONE: re 4W Pepip�1�®art
SIZE OF IMPROVEMENT
LENGTH WIDTH
HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
❑ HOUSE & GARAGE
1. Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1. Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGSYes []No LOCATION OF WINDOWS
FOR WINDOWS — PROVIDE U -VALUE AND
OR FOR NEW OPENINGSCCCCD____ESCRME SIZE OF
MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE.SCHEDULE)
TOTAL JOB VALUATION $ 0 —7OCCUPANCY TYPE
Permit Fee See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ 110 .001 times the total job valuation
Surcharge $ .0005 x Permit Valuation Minimum $.50
License Surcharge $ $5.00 (State Licensed Residential Contractors)
SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft + 6 ft = ft x $24 = $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( )
Total Due $ d Make checks navable to: Citv of Fridlev Attach Stioulations
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 ordLances codes of theeity of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an applicpermit d rk i of to start without a permit on site; that the work will be in accordance with the
approved plan in the casewhic q i approval of pla s. /
SIGNATURE OF APPLICAN PRINT NAMEATE (0
f PLEASE NOTE: SEPARATEPER11%IITS ARE REOUIRED FOR PLUMBING. ELECTRICAL AND MECHANICAL WORK I