PRE 2010 DOCSJ
SUBJECT
City of Fridley(
4 5 s�
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
Ir?
� • COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
�
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED By
612-571-3450
910-F15
8/30/96
JOB ADDRESS 7686 Van Buren Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
2
1 Shaffer's Sub. #1
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Dan/Gail Roufs 7686 Van Buren Street
780-3267
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
❑ NEW [ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 14' x 14' Shed addition to garage; reroof garage (8 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
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
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
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
$2,000
$1.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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-
$62.25
Fire SC $2.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
OTAL FEE
$65.25
SIGNATURE OF CONTRACTOROR AUTH 1111 10
N P P RLY V LIED THIS IS YOUR PERMIT�
&AENT
l
4
LCIN,&
MATE
SIGNATURE OF OWNER IIF OWNER BUILDE IDAT I
J
NEW { j Effective 3/1/96
ADDN [ ] CITY OF FRIDLEY
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress:NE1
Legal Description:
Owner Name & Address: ( I �� i��� Tel. #
Contractor: 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 EMPROVFA ENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width ` HeightSq. Ft. ME 5 -
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:i, ��r _ ��� ` Caw
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Wccd Estimated Cost: $ 00 0. ®t�
Approx. Completion Date:
k(Cost on Bac)
a ,`..
ekl
Driveway Curb Cut Width Needed Ft - + 6 Ft = t. x
SATE: $ APPLICANT: ¢ Tel. # _ 3
CITY USE ONLY
Permit Fee
$ �
>i -Fee Schedule on Reverse Side
Fire Surcharge
$ z) C)
.001 of Permit Valuation (1/10th%)
State Surcharge
$ / 6E)
$.50/$1,000 Valuation
SAC Charge
$
$900 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 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 $100,000 plus $5.00 for each additional
$1,.000 or fraction thereof, to and including $500,000
t.'
$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 tunes$13'
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide `' g
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 it has been constructed .
will be required before proceeding with the framing.
s
SUBJECT
City of Fridley6'
AT THE TOP OF THE TWINS
P,
BUILDING PERMIT
If
COMMUNITY DEVELOPMENT DIV
t. PROTECTIVE INSPECTION SEC.
r
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
' 612-571-3450
910-F15 T6/6/97
JOB ADDRESS 7686 Van Buren Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
2 1
Shaffer's Subdivision #1
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Dan Roufs 7686 Van Buren Street NE
780-3267
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
❑ NEW ❑ ADDITION ❑ ALTERATION J7 REPAIR
O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House (17 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$1,402
$.7O
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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.
PLAN CHECK FEE
TOTAL FEE
$50.60
NATURE OF CONTRAC ORA ORIZED AGENT i/D{®ATEi
WHEN PROPERL ALIDATED THIS IS YOUR PERMIT
(/Jnr
BL 1 INSP
MATE
SIGNATURE OF OWNER OF OWN BUILDERI I ID TEI
NEW [ ] Effective 1 / 1/97
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: _ & 9& i f A- A; 0V I/ f !,)
Legal Description:
Owner Name & Address: �� o _ �(� I,' e,, ��� �r„ St )t/,F Tel. # �7e0 - 3, CP
Contractor: ----
Address:
MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
LIVING AREA:
Length
Width
Height Sq. Ft.
GARAGE AREA:
Length
Width
Height Sq. Ft.
DECK AREA:
Length
Width
Hgt/Ground Sq. Ft.
OTHER:
ro G 4,
i -{G o S E'_ .-eco il- C 42 -9 -
Construction Type:
$
$5.00 (State Licensed Residential Contractors)
Estimated Cost: $
$
Alt. "A" or Alt. "B" Above
Erosion Control
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft.
+ 6 Ft =
Ft x $ _ $
DATE: (e Z APPLICANT: /V R 0
V Tel. # 7 k -V - 3 (j
TOTAL
STIPULATIONS:
$ C"n
CITY USE ONLY
Permit Fee
$ S!�
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ `�
$.50/$1,000 Valuation
SAC Charge
$
$950 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
-$450.00 Conservation Pian Review
Park Fee
$
Fee Determined by Engineering
Sewer. Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS:
$ C"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 amou nt
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 $10,000
$100,001 to $500,000
$887.25 for first $100,000 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.
klternate "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
"omits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
-view of the proposed structure and of the construction site.
Certificate of Survey of the lot, showing the location of the foundation cjnce it has it has been construe -.f
I he required hefore proceedina with the framing.
CITY OF FRIDLEY INSPECTION DIVISION 95
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential Rate TOTAL
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace $ 30,00 $
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace) $10.00 $
Gas Range $10,00 $
Gas Dryer $10.00 $
fir Conditioning — All Sizes $ 25.00 $ 2 5
All Others/Repairs & Alterations (UST ON BACK)
1 % of Value of Appliance or Work $
Commercial/Industrial
1.25% of Value of Appliance or Work $
Effective On January 1, 1997
JOB ADDRESS
The undersigned hereby makes 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 Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
- l ,1998
OWNER lD
BUILDING USED AS
ESTIMATED COST PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units,
Trade Name -
BTU
Circle One (Steam) (Hot Water) (Warm Air)
Size No.
HP
EDR
Fuel Total Connected Load
State Surcharge $ .50 Burner Trade Name
le
TOTAL FEE A> O BTU
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
HEATING CO
Signed By
Approved By
Size No.
HP EDR
shat;
Heating end .Air Conditioning
/ Columbia Heights, PSN 55421
Tel *2.,572-0459
Ila I
ugh—In Date Final DateG'it
*Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOR STACK VERIFICATION ON
written permission from adjoining property owner. REPLACEMENT FURNACE
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CHIlANEY 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 (
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:
011
suB.iky
P
City of Fridley
2 9207
AT THE TOP OF THE TWINS
D A A IT
B I' I L D I N G PE
i
• COMMUNITY DEVELOPMENT DIV.
v "'v 1L
R.
_____
d � � PROTECTIVE INSPECTION SEC.
!
1 � �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
1 = "'-'1 CITY HALL FRIDLEY 55432
j 612-571-3450
910-Ft5
4/14/99
/
10B ADDRESS
7686 Van Buren Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
2
Shaffer's Subdivision #1 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Dan Roufs 7686 Van Buren Street NE 780-3267
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Ea leview Construction Inc 2937 174 Lane NW Andover MN 55304 753-5469
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
20076043
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (24 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
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 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
$2,056
$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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE/
TOTA EE
Y�
Licen e $5.00
$82.84
iDATE4
N P OP L A ISIzr0?"_11S
,,�NATUREIIJFCONTRACTORORAUTHORIZEDAGENT
LD INso Ar1AtE
SIGNATURE OF OWNER11F OWNER BUILDER, IDAiE.
011
NEW [ ]
Effective 1/1/99
ADDN [ ] CITY OF FRIDLEY le
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
r
ConstructionAddress:�P��
Legal Description:
Owner Name &Address: Tel. # �Jb � �
Contractor: MN LICENSE # mac? to ® �
�t
Address: A/- V, Tel. # � —S y le?
�� � % i % �
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:
.S�
Construction TY! eL�e: � -9- 71"-a C stimated Cost: $ w
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x
DATE: �/Zly
Lqa( APPLICANT:
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
GI
;a
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 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 applicatign 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 $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 $100,000 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 $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.
3uilding
BUILDING
Permit No.:
nspections -
RESIDENTIAL APPLICATION
ReceiveA—
763-5723604
CITY OF FRIDLEY
Date Rec'd
)ATES' O�
YOUR E-MAIL ADDRESS bYY G1Q%h,No td 6L6t3/5IryC. Cep:+-...
;ITE ADDRESS
HIS APPLICANT IS:
❑ OWNER CONTRACTOR
PROPERTY OWNER/
NAME: 'tkoW � GAIL. 0,0U,Fs
3�
ADDRESS: �69AA &-1 ",1 SV /E CITY 'or:r
STATE#AV1P
TENANT
PHONE: `763-i8b-- 37-6-7
CONTRACTOR
NAME: �dvv�ir+ia-sem 'Btu, Qers �.
/
STATE LICENSE # Z U 2-5 b '� E, EXP DATE 3%31 4-
/ 'b 6c"'I'Iiv AVe A/ A)/'%f 1Lu/k,— sTAT IP
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
-;57/6
WITH APPLICATION
PHONE 657- FAX 661- 76--L - 86 /
PROPERTY TYPE
GLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITIONGE/SHED ❑ WINDOWS
E3BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:W
❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: Remove � Re ta4-a a -r -e-C�
SIZE OF H*APROVEMENT e LENGTH off- 6 WIDTH 9
HEIGHT 861 Sq. Ft.
ROOFING t
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGES
5F
❑ ATTACHED GARAGE
I. Existing Floor Plan
2. Proposed floor plan
PROPOSED SIZE!
DETACHED GARAGE
3. List
of structural members to be used
PROPOSED HEIGHT: 9, w"4&
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
I9Soffit1
ADDITIONS, & PORCHES SUBMIT:
13 Aluminum
® Trim "' ^u"
1. Site Plan/Survey showing the existing structures
0 Other °emeA jar, ,
/I
® Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes
❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
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 FLEE SCHEDULE)
TOTAL JOB VALUATION $ ;;�2 , 4 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
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)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks uavable to: City of Fridley Attach
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 andwo is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all workch requires review approf plans.
SIGNATURE OF APPLICANT �r —` PRINT NAME JAAEs1L i SR �i 1� DATE S "ZS _O -b
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 $23.50 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 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 I"$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 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 161 $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 proposad 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
Home Owner
Dan & Gail Roufs
7686 Van Buren St NE
Fridley, MN 55432
763.780.3267
Contractor
Dominion Builders, Inc.
12240 Goodview Ave N.
White Bear Lake, MN 55110
651.238.9882
PROJECT: Removal of existing detached 20'-6" x 22'-0" Stucco garage and pad and replace with 22'-6" x
42'-0" Stucco garage and slab in exact location with respect to the lot line setback.
Details:
2x6-9' walls (green treated plate on concrete and double SPF as top plate)
V2" OSB wall sheathing
HIP roof system (with energy heals) —18" overhang
V:e' OSB roof sheathing
Aluminum soffit/facia
Iee/Water guard (2 -rows) around perimeter of entire building
15# Felt paper for balance of roof
3 -Tab asphalt shingles
Roof venting (64750 (8") vents)
Green guard house wrapped
James Hardie Stucco sheathing -siding (4x9-3/8" panels)
Main garage area insulated with R19 in walls and R38 in ceiling
Vapor barrier, Drywall: taped /mudded/sanded ready to paint
One 16'x7' insulated garage door
Two 3/0 service doors
Exterior lighting over/near each door unit
Rr`
Au�.25. 2006 12:25PM OSVOLD CO 612 331 5540 No-9315 P. 3/3
07 ui—ceiri-3 Lo-46 yo0 TITLE,W UUL-.j r-HcMM.3
U A i guc/t Euits 100
�INC.1 317 second avenue south
minneapolis, minnesota 55401
• (012) 339-5313
LEGAL DESCRIPTION,
INSPECTION ®ATE a r_� FILE NO.`�
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Effective 1/1/04
CITY OF FRIDLEY MOVING [ ] RECKING ] PERMIT APPLICATION
6431 University Ave NE
Fridley MN 55432
(763) 572-3604 FAX (763) 571-1287
Job Address: VatPcx rem Sk ae
Legal Description:
Owner & Address : Oua�Ga 1 lou 's as c Tel. # 7So - 3z6 7
Contractor: �omori���3�a mac_ el. #
Address: IZZ40tv'�oac v� re [Q/jk cEtt. 'LdcQ�-State License # 2G2C30S(.;'
DESCRIPTION OF BUILDING
HOUSE: Length
GARAGE:Length
OTHER: Length
Estimated Cost
S --L '
Width
Width
Width
Height Sq. Ft.
Height �� Sq. Ft. 4S6
Height Sq. Ft.
Approx. Completion Date
Cu. Ft.
Cu. Ft.
Cu. Ft. _
-711.5-10 r -
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. CALL ALL
UTILITIES FOR DISCONNECTS BEFORE WRECKING MOVING STRUCTURE.
Water Bill Paid: Yes [ ] or Collect [$
Moving Route:
] Signature
The undersigned hereby makes application for a permit to wreck/move the building described above, agreeing
to do all work in strict accordance with the City Ordinances and rulings of the Building Division, and the State
Code which requires any water well on the property to be sealed by a State licensed water well driller, and
hereby declares that all facts and representations stated in this application are true and correct. ALL
Moving Wrecking
Principle building into Fridley .... $300.00 For each 1,000 cubic feet or fraction ...... $1.25
Accessory building into Fridley ... $ 42.00 For structures which would be impractical to
Through or within the City ...... $ 20.00 cube, the fee shall be based on the total cost
Move a building out of City ...... $ 20.00 of wrecking at the rate of $6.00 for each $500.00
or fraction.
PERMIT FEE: 301�z MINIMUM $20.00
STIPULATIONS:
From: City of Fridley I a WZ_V d-"[5 rage: 4/o Lith@: iNL11AM I C.".'00 AM
Building
MECHANICAL
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By.
763-572-3604
CITY OF FRIDLEY
Date Rec'd:
DATE YOURE MAIL ADDRESS \�VI!E�'t )m
SITE ADDRESS 9 CD sto IT62i't
THIS APPLICANT IS: 13 OWNER NTRACI OR
PROPERTY
OWNER/
NAME:
® n2 Te STATE � 757!j
ADDRESS: ®
PHONE: 1 �
CONTRACTOR
COMPANYNAME:
SUBMITA COPY OF
YOUR STATE
LICENSE WITH
CONTACT PERSON:1 Q f� 1, iY>
STATE LICENSE #L I��®b EXP DATE ®g p
' CITY � . 1.t-9 'IF. I'�IN'STATEZ1P
ADDRESS:
APPLICATION
pHONE FAX 9 i5,2, 2J9 - 44-25
PERMIT TYPE
KSINGLE FAMILY O TWO FAMILY O TOWNHOUSE
K
TYPE OF WOR:
�Ww ❑ REPLACEMEATT TERATIONIREMODEL
DETAILED DESCRIPTION OF WORK =Y')' -ZS Ml 44�,� A e--);,
O&qinLQ ` bV ow_ (S�-
PER MS 16B.665 the permit fee is a minimum of 515.00 or 5% of the total cost up to SSM.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 la BO 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) r
Egarprta hidaUed MFG: Oi'San MODEL: IRAD "- A-010 SMMTU I&PPY
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZEIBTU
A/CW.00 (GAS) $15.00 _GAS RANGFIOVEN $10.00
_FIREPLACE
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00
BOILER $35.00 34URNACE $35.00 _GAS UNIT HTR $10.00
LINER $10.00 GAS DRYER $10.00 _POOL HEATER $35.00
_XCHiMNEY
DUCT WORK $10.00 YGAS PIPING $10.00 _VENTILATOR $15.00
Permit Fee $
Number of fixtures (o, $10.00 x $10.00 = $
Surcharge S .50
TOTAL DUE $
Number of fixtures (o, $15.00 ®' x $15.00 = $ —
Number of fixtures @ $25.00 Q x $25.00 = $ —
Number of fixtures (a), $35.00 x $35.00 = $
State Surcharge = $ .50
Total = $_Lat2,C%
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 odes 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 to start without a permit; that the work will be in accordance with the
approved plan in the case of all work mbich regi' review proval of plans.
SIGNATURE OF APPLICA PRINT NAME F ie_ &nI DATE
It
City of Fridley
Building Inspections Department
6431 university Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4