PRE 2010 DOCSVillage of Fridley, 311mm.
BUILDING PES.
N® 2 9 Office of INSPECTOR OF E , INGS
i
Owner
Architect Fridley, Minn., 19 "ah
l Builder i
LOCATION OF BUILDING
No. Street Part of Lot
ff-f
Lot Block A clition or Sub -Division
i
Front,
f• To be used as_
DESCRIPTION OF BUILDING
Height ) Stories Manner of Construction
To be completed Vii• Estimated Cost
v 1
Permit is hereby g tanted to- ,r ! r�i.r,a ,s
the building is �n �1 described in the above statement. This permit is granted
upon the express c 'nditlon that a person to- whom it is granted, and his agents, employees and workmen, in all
the work done in, around and on said building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley,'IMinn., regarding the construction, alteration, maintenance, repair and ,moving of buildings
within the city li ts, and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
4'3nspector of Buildings.
In consider,
the above peri
above set, forth
sworn, I hereby
true as therein i
Subscribed an
day
AGREEMENT A.IID .SWORN STATEMENT
+f the issue and delivery to me by the Inspector of Buildings of Fridley of
ereby agree' to do the proposed work in accordance with the description
,cording to the provisions of the ordinances of Fridley, and, being first duly
and say that the facts stated by me andcontained ' the above permit are
sworn to before me at,'Fridley, Minnesota, t]
City of Fridley, Mim.
BUILDING PERMIT N® 37,34
Date: ... ........................ .......
Owner ....................................... Builder A Z. ............... .............
r
Address...................................... Address .............................................
LOCATION OF BUILDING
No.../. Street ��F'l... �zPart of Lot ...............................
Lot ............ Block .................. Addition or Sub -Division .......................................
Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ...........................
DESCRIPTION OF BUILDING
To be Used as:
K .
• A/rirt1--v..... Front SQ . ® Depth 99."- Height Sq. Ft. . MPf. Cu. F*V'/ P
.................... Front ........ Depth ........ Height ........ Sq. Ft......... Cu. Ft. ........
Type of Construction ................... Zit. Cost...../. / 404:
...-. To be Completed ..............:....
In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do
the proposed work in accordance with the description above etf..in comliance with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $.... 49....., 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 with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. s-
•o3,.o�a�df% ....... 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.
SUBJECT
PZR
City of Fridley
15fAT
THE TOP OF THE TWINS
BUILDING
PERMIT
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
NUMBER
REV.
DATE
-OF
PAGE
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
8/22/86
JOB ADDRESS
6452 Van Buren Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6-8
4
1 Florence Park Addition
to Fridley SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Patrick Wisniewski 6452 Van Buren Street N.E.
571-6292
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
North Central Builders 7401 - 42nd Avenue North, New Hope 533-6168
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
55427
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
-
7 CLASS OF WORK
❑ NEW ❑ ADDITION C1 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof & reside
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
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
$9,800
4. 90
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
OESNOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
P OVISI NS F ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$80^50
ST U TION O THE PERFORMANCE( OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$85.40
NATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY LIDATED THIS IS YOUR PERMIT
p ..
BLDG INSP
r)ATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATEI
NEW [ J
City of Fridley Effective 4/1/86
ADDN. [ l FR -1 AND R-2
ALTER. [ J Building Permit Application
Construction Address:-- $ � � � 41AAI 6,a vtr k-.7
Legal Description:
Owner Name & Address: _ �i�TRlcl� Lti� r� Tel. #
Contractor:
Cal) TAA Tel. #
Address • 7,/,D I AV- -") ®. Nvlk) Sly- -moi
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Corner Lot [
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.
J� tC t{&L V� f 'rt /t 4Z 6 IL- a <<<) /9 C' 5 rtF it L //q (, OK I- X I A '
Inside Lot [
Type of Construction:
Approx. Completion Date:
Ft. Yd. Setback Side Yard Setback
Estimated Cost: $ ® C5
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
p� 1�,._,__ .-/-��-� Tel.
DATE: o%�/S� APPLICANT
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$4175 per SAC Unit
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 Valuation Fees
$1.00 to $500.00 $10.00 (Minimum Fee is $15.00)
$501.00 to $2,000.00 $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.
I
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
.tESIDENTIAL
RATE
TOTAL
Furnace Shell and Duct Mork,
furnace)
S
20.00
$ Q
Burner (Also replacement
Gas Piping
$
10.00
S
(piping needed with new furnace)
Gas Range
$
10.00
S
Gas Dryer
$
10.00
S
• Air Conditioning (all sizes) $ 10.00 S +0 -OD
All Others/Repairs and Alterations
11 of Value of Appliance or Mork S
COMMERCIAL/INDUSTRIAL
10 of Value of Appliance or Mork
State Surcharge
Reinspection Fee ($15.00)
Rough Inep.
Date
Final Inep. 114e "
17
Date
Approval for Permit
MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00
PLUS $.50 STATE SURCHARGE
s
Attach stack verification fors with replacement furnace permits
*Air Conditioners can not bo placed in side yard without
written permission from adjoining neighbor.
Effective Aug. 1. 1981
Job Address to 4S _I fl n �-
Department of Buildings, 6431 University Ave. N.E.• Fridley, MN S5432
City of Fridley
Tel. 0571-3450
The undersigned hereby make# application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are trueandcorrect. r/
Fridley. -Minn. e 1 y • 19J
OWNER i Q ll� .I C/s\� �1Owe
KIND OF BUILDING/,ILQfYtI� ,
USED AS 010
70 BE COMPLETED ABOUT
ESTIMATED COST A -sm — _
OLD - MEN BUILDING PERMIT NO. PERMIT NO.
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam. Not Mater Mars Ai No. i
Trade Name (2ilia (ZA' site No. U.) ® (D 0 4�
Capacity Sq. Ft. EDR BTU NP
Total Connected lead Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU NP
Y
Company
Signed By
UN
Tel I. No. ln
5 0 - U
01
SUBJECT
City of Fridley
2 9 893
AT THE TOP OF THE TWINS
IIL®ING
BUILDING
DEDA AIT
---�� COMMUNITY DEVELOPMENT DIY.
INSPECTION SEC.
f � � PROTECTIVE
1 . �
1 "'1 CITY HALL FRIDLEY 55432
NUMBER
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
FRV
7/19/99
JOB ADDRESS 6452 Van Buren Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6-8
4
1 Florence Park Addition to
Fridley SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Pat & Jane Wisniewski
571-2481
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Dave Wiger Const. 901 Rice Creek Ter NE Fridley 5543
572-8403
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 X® REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof (20 Sq) Tear -off; Reroof (4'1/2 S Rolled roof
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
OCCUPANCYLOAD
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
2048
$1-03
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-
STRUC N OR THE PERFORMANCE OF CONSTRUCTION
$83.25
PLAN CHECK
TOTAL F
NATURE OF CON'a CTOQ OR AurrIOQIZED AGENT IDATEI
WHEN O
ALIOATE IS LR PE T
`$
S-GNATUAE OF OWNERoF OWNEABUILDERi IOATEI
BL 'NSF'
TRATE
01
do
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION °'� L\
Construction Address: 6V�,:2 60 &*
Legal Description:
Owner Name & Address: (Pi9 %� �l� e(.l�L14j/,�Aii_xw / Tel. # LS_
Contractor: ®'N U_F.GAJ/��ii�' MN LICENSE #
I`
Address: �� /' ee'r � ' ,�' ��/�i� Tel. # 5_7v2 —,-F
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
GARAGE AREA:
DECK AREA:
OTHER:
Length Width
Length Width
Elv_) F 7_140A d
Height
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
4 AF 400
e_
�26 7q c� ed C e Ad�A'
Construction Type: Estimated Cost: $�/�,�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ ��7 U
DATE: -Te 1 y
APPLICANT:
D, %W / G4rt Tel. # �'
CITY USE ONLY
Permit Fee
$ (�
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ lo. -3
$.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC Unit
License Surcharge
_
$ 06
$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:
- .. 0
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
Inspections
763-572-3604
DATE
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
0 OWNER ONTRACTOR
COMPANY NAME: I
CONTACT PERSON:
STATE LICENSE IE!Yo 3 D TE —
ADDRES : CITY
PHONE _ FAX
t �SINGLE FAMILY 0 TWO FAMILY
VNEW 0 REPLACEMENT
DETAILED DESCRIPTION OF WORK
0 TOWNHOUSE
0 ALTERATION/REMODEL
Permit N6&)_
Received By:
Fj
ATE ZIP
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
should only the cost of labor )
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This reflect
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) MODEL:
MFG
SIZEIBTU
Equipment Installed
MFG: MODEL:
SIZEIBTU
MFG: MODEL:
(GAS) $15.00
SIZE/BTU
—GAS RANG
A/C $25.00 _FIREPLACE
TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00
RILL $ 0.0.00
NEW GAS GRILL 0.0 00
GAS UNIT HTR $10.00
_AIR
_BOILER $35.00 _FURNACE $35.00
LINER $10.00 _GAS DRYER $10.00
POOL HEATER $35.00
VENTILATOR $15 00
_CHIMNEY
DUCT WORK $10.00 GAS PIPING $10.00
xe r,L ,.mwr...vxwt,.rrurt�r�Txmnv "ur soda-criv a, wrr.�a.�iii
�✓3:r1,C5;Wa+-wrc'.diw3r.%ntTvu'c:.r+'e:.d9. '•ai:+e.roue5c - ...a. s.,..,._ ,.....««_... _ _ _.
Perm`!it Fee $ Number of fixtures @ $10.00 x $10.00 = _
Surcharge $ .50 Number of fixtures @ $15.00 _ _ x $15.00 = $_
TOTAL DUE $ __1,4__• Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ _ _.550
Total = $
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 work is not to start without a permit; that the work will be in accordance with the.
approved plan in the case.. of ll worlC�which
yeires review and approval of pl s// 1 �nU.�ln
SIGNATURE OF
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
t-
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
' RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEWIEXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or PropanoUGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances 1FGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation .
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
a. ACOA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make up air calculations
Building
BUILDING
Permit No.: 0-6
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Dat
763-502-4977 FAX
EFFECTIVE 1-1-2010
DATE-/ — 2 010
YOUR E-MAIL ADDRESS
SITE ADDRESS !oI- f SoZ
VaAn aur e v-, St a ) F
THIS APPLICANT IS:
❑ OWNER C;t1,ONTRACTOR
PROPERTY OWNER/
NAME:
TENANT
ADDRESS: CITY
STATE ZIP
PHONE: 7a2
CONTRACTOR
NAME: -M4 c .
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE o`? OS(o S 4 S EXP DATE
AND CERTIITCATE OF
ADDRESS: j pk,�` (Q M 0'4%l _!_ J 1 t3 L✓, Al
CITY 4GyIP 6i'd V2 STATE.MAIP49
INSURANCE
PHONE 70- y93- a FAX
PROPERTY TYPE
I$ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ACWINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER.
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: iitJivnr i^ls-
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
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 'XYes ❑No LOCATION OF WINDOWS
FOR WINDOWS - PROVIDE U -VALUE AND
OR FOR NEW OPENINGS -DESCRIBE SIZE OF All
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 $ O_0 �= OCCUPANCY TYPE
Permit Fee $ 1 '5cl 2—G See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ ) .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 $22 = $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( )
Total Due $ C,L9 Make checks Davable to: CRY of Fridlev 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 work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the cgLee of all work which requires review approval of plans.
SIGNATURE OF APPLICA —��PRINT NAME ®Vie &�-, 4 4 � DATE / — /I - r,26 / (�
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,$0 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 I" $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 forthe 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 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