PRE 2010 DOCSVillage ®f Fridley, Minn.
BUILDING PERMIT ° 1753
Date: ....� '.......
Owner....................................... Builder ......�............. t .......
Address...................................... Address ..!............ ...
CA ONF ®UILDING
No..�.�. �.... Street............. �.... Part of of.....
Lot ... .... Block ....... a........ Addition or Sub -Division ..........
Corner Lot ........... Inside Lot ... �<... Setback .. .. Sideyard .........
DESCRIPTION OF BUILDING
To be Used s:
a ... ........ ........ ........
Front 9 Depths �' Height % Sq. Ft. Cu. Ft.
..................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........
CP ®0
Type of Construction ?"a r ...... 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 village of Fridley.
................................................
-:
In consideration of the payment of a fee of $1. permit is hereby granted to ......... .
n
to construct the T} ildii g or addition as described above. This permit is granted upon
the express condition that the person ta:wf om it is granted and his agents, employees and workmen, in all work
done in, around and upon said by ldf , or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regardin dc'cation, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
�v
.Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
01
Building
PLUMBING
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRRyDLEY
nate Rec'd: 5:ffjo,
YOU -MAIL ADDRESS
1 ` ' a ` D R E
SITE ADDRESS L0,1% e 11t Pf�t
_
THIS APPLICANT IS: ❑ OWNER WCONTRACTOR
PROPERTY
I, OWNER/
n
�'! G►�X _
NAME: 4Ai &I 4 41
STATE IP 5 S Y3
ADDRESS: CITY
TENANT
p_ �
'
pHONE:�(®3 � K✓
i CONTRACTOR
h
°
NAME:
II SUBMIT A COPY OF
STATE LICENSE # EXP DATE C9
YOUR STATE
I,
ADDRESS:56101150 HMO CITY STATE ZIP
1-5w,>-
LICENSE WITH
PHOSi
APPLICATION
PERMIT TYPE
i
DINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
i
TYPE OF WORK:
0 NEW REPLACEMENT
DETAILED DESCRIPTION OF WORK Fhdadg.Z J12
I
PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
iimprovement, 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, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SINK/LAV DRAINS _ SHOWER _ WATER PIPING
_ `FLOOR
_ BATHTUB _ GAS PIPING � CraucmaO _ SWIMMING POOL _WATER SOFTNER ($35)
KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
_ CLOTHES WASHER _ _ _
DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
_ WATER METER—OTHER
PERMIYFID PRO
Permit Fee $ . ou
Number of fixtures @ $10.00 x $10.00 = $
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $
TOTAL DUE $ r;
State Surcharge = $ 50
Total = $
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
1 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
but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
not a permit
approved plan in the case of all w r which,requires review and approval of plans.
fly� t
1 DATE 11'.;o
SIGNATURE OF APPLICANT PRINT NAME IdI
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building
$
BUILDING
$
Permit No. la �J
Inspections
Surcharge
RESIDENTIAL APPLICATION
Received By A
763-572-3604
SAC Charge
$
Curb Cut Escrow
$
Erosion Control
$
CITY OF FRIDLEY
$
Da � . ' `'
763-502-4977 FAX
Total Due
$ q9 Z
EFFECTIVE 1-1-2010
41
DATE L9 A
YOUR E-MAIL ADDRESS
SITE ADDRES
7
THIS APPLICANT IS:
❑ OWNER WONTRACTOR
PROPERTY OWNER/
NAME: \
TENANT
ADDRESS: C�Z'�S� �� �ECTTY
STATE ZIP
PHONE: 5—,b:7 a L
CONTRACTOR
NAME:
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICEN EXP DATE
W2
AND CERTIFICATE OF
ADDRESS: CITY ® STATE ZIP /
INSURANCE
PHONE (� ® FAX
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILYMW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING A,0THER
❑ SWDAMING POOL
TYPE OF WORK:
ONE HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCEIREPAIR '❑ REMODELING
DESCRIBE WORK BEING DONE: 4113z.i
SIZE OF IMI'ROVEMENT TMZ® LENGTH WIDTH
HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
13 HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
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
I. Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
FOR WINDOWS — PROVIDE U -VALUE AND
OR FOR NEW OPENINGS -DESCRIBE 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)
COTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
$
Plan Review
$
Fire Surcharge
$
Surcharge
$
License Surcharge
$
SAC Charge
$
Curb Cut Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge
$
Total Due
$ q9 Z
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2100 per SAC Unit (Plans to MWCC for determination)
Iq
ft
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMITNOT 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 work is not to start without a permit on site; that the work will be in accordance with the
approved plan in thew k which requires review and approval o • s.
SIGNATURE OF APPLICANT PRINTNAME �DATE 1p
A
Page 2 - Building Residential Application
BUILDING PERMIT FEE SCHEDULE
The Chief Building Oficial shall, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or structure, or for any alteration or repair
to any existing building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
provided to -wit:
TOTAL VALUE
FEES
$1 to $500
$23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000
$23,50 for 1"$500 plus $3.05 for each additional $100 or fraction, to and
including $2,000.
$2,001 to $25,000
$69.25 for 1' $2,000 plus $14 for each additional $1,000 or fraction, to and
including $$25,000
$25,001 to $50,000
$391.25 for Xs'$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 1s` $50,000 plus $7 for each additional $1,000 or fraction to and
including $100,000
$100,001 to $500,000
$993.75 -for I s' $100,000 plus $5.60 for each additional $1,000 or fraction to
and including $500,000
$500,001 to $1,000,000
$3,233.75 for the V $500,000 plus $4.75 for each additional $1,000 or
fraction to and including $1,000,000
$1,000,001 and up
$5,608.75 for the 1' $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
2�
�
Or
2,
21491
Street
Property Line
Revision #:
Scale:
Landscape Plan: 6281 Trinity Dr NE, Fridley
Landscape Design by: Brett Lundgren
Date: 4/19/2010
of 111 = 81 o°
Yenish Residence
Selfscapes 612.718.7091