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PRE 2010 DOCSr City of Fridley, 6431 University Ave. NE., Minneapolis, Minn. 55432 BURDING PERMT . T. 41e owner: _ Smith & Anderson Inc. Builder Roger Brenny Address ___.912- 40th Avenue N E Address Route #3,, Foley, Minnesota LOCATION F BUILDING No. X75 Street Washington Street N E .Part of Lot Lot—9_.1Q_._..__- Block __.....:...._._L.____._. __ Addition or Sub -Division Adsms rppAddition_ Corner Lot ___ Inside Lot X Setback 35' Sideyard 10'-5' *Y* Elevation ....__ 857.69- Wye 57.FitWye Top of Footing DESCRIPTION OF BUILDING To be Used as: Dwelling _^ Front 26' Dept 42' Height 20' Sq, FL 1092'" Ct,. rt 20.240 _ Ca,rage__.._.__..._._... Front _ 9-0' Depth 261 Height _12' _ Sq. Ft. 9741 Cu. Ft. _9470_. Type of Construction Wand Frame Est. Cost ..._._$20.,.$56 -On To be Completed jTuly 1 , 1972 Stipulations: Provide a hard surface drive and verifying survey before capping. WATER LOCATION: 219' S. of Manhole. 10' North of Sewer Service. SEWER LOCATION: 229' South of Manhole In consideration of the issuance to me of a permit to construct the building described above, Y agree to do the proposed work in accordance with the description above setforth and m compliance with all provisions of ordinances of the city of Fridley. 10.43 State In consideration of the payment of a fee of $.?0,00 —,permit is hereby granted to Roger BE nv..Contra.ctol 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 ordingnees of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings wyithin the city limits and this permit may be revoked a t any time upon violation of any of the :provisions of Said ordinances. XZ --a X�dtng Inspector CL•ARENCE BELISLE NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Ba sure to we the Building Inspector for separate permits for these hems. APPLICATION FOR RESIDENTIAL, ALTERATION, 1. /ovo '3 �7� %/ OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAM: f/ ®,� rs� BUILDER:, ee, �i f5 K___" dz ADDRESS /2 �Z4 ADDRESS: �4✓ s�, ��,3.3'��, ,�,v��`l� ����`o ,l'�1so 0 40 NO •� STREET: LOT: BLOCK: ADDITION: CORNER LOT: INSIDE LOT: el SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: Front: r Depth: Height: Square Feet:_ Cubic Feet: a ;2 KC2 a ' G: Front: ® Depth: 7 % Height: /g Square Feet; ? t —Cubic Feet: Type of Construction: �Zajr,'eA11 '&7 Estimated Cost: $ a, To Be Completed: a �. /�/ ��-t The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict 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: SIGNATURE (See Reverse Side For Additional Information.) BUILDING PERMIT FEI SCHEDULE SECTION 2. The Inspector of Buildings 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 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 iRl the manner herein provided to -wit: UNIFORM BUILDING CODE: Type 1, 2 & 4 - $2.15 for each one thousand cubic feet, or fraction thereof, in such cubical contents. Type 3 & 5 - $1.55 for each one thousand cubic feet. 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 lin,- of the basement or the cellar to the average heights of 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 $5.00. VERIFICATION OF FOUNDATION NOTE: 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 Certified Survey of the lot, showing the 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. AGREEMENT DATE �" � ���,' the owner of the 22SI, following described property Hereby agree to pay in cash $ ro ortionate to the city of Fridley to cover lieu thereof agree share of the ,utility system, or in pinst the - to have the City levy an assessment ag property described above to cover the cost of my • share of the utility system as pro- proportionateassed vided in Section 2 of Ordinance No. 113 ember by the Council of the Ci of Fridley on D 11, 1958. 1 Tapping Permit No.----- is 1il fill 11S Is11S 11 : E8 GA4 EIEC PtIIMT111fG FIXTURE RATES- RATE TOTALC1 /y Number FixtuRes ................ �NO. x o $ Future fixture Opening .... ® ..... • x $1.50 $ New .7ixture Old Opening .......... x $1.50 $ Catch Basin . . . . . . . . . . . . . . .. . .. . x $3.25 $ Water Heater 'Up to 99.000 BTU) .... ®.� x $3.00 $ New Ground Run Old Bldg..... ®... x $3.25Elootec S Wates Hqatw $22.00 $ .............. - GAS FITT9KG FEEM NO. RATE TOTAL lat 3 Fixtures .... • • • • • • .. • • ...• • _____ _ x $2.00 ry^- $ = AdffiAonal Ybdum ................ -x$.76 $ Gas Rafte to 199.000 BTU .. 4.... o .... x $5.00 0 - State Surcharge State -Surcharge $ .50 REPAM L AL TIO for to Description .. o .......... a ..... a ..................... TOTAL T=__ City of Fridley. . ce. The undersigned hereby makes application for a permit for the vrork herei,: specified* agreeing to do all work in strict accordance with the Qty Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representation stated in this application are true and correct Eel=. Kind of lia`_l To be completed about Estimated Cost. $ Old Neve: Building Permit No. z/L-Z 9 -Permit No. Signed By x�/J -m— Business Phune No ROUGH FINAL Fa Application for Power Plants and Healing. Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... $10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 , each add. 60,000 BTU .................... — 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ....... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 $ Each add. 320 sq. ft. EDR Hot Water .................. 3.00 $ OIL BURNER—to 3 gal. per hour ........................ 6.00 $ over 3 gal. per hour—See Fee Schedule ROUGH FIgAL Dept. of Bldgs. Phone 560-3450 City of Fridley: The undersigned hereby makes application for a permit for the work herein. specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. 0 Fridley, M Owner Kind of Building ��� Used as ez 4 ®/� To be completed about ����/�� X40 Estimated Cost, $ Old --& Building Permit No. Permit No. ;26? DESCRIPTION OF WORK HEATING or PO team, Hot Water, arm Air No Trade Name ��� , z� Size No Capacity Sq. Ft. E.D.R.BTU P. Total Connected Loa wl , ,g Kind of Fue BURNER —Trade Nam e�� Size Capacity Sq. Ft. E.DR BTU H.P. (REMARKS -OVER) "Y N. WELTER HEATING CQ Signed 4637 CHICAF-4® "9- MINNI"MUS 7, MiNNElS®T,# By CQgO.4P Business Phone No- ®�A/5 GAS BURNER (up to 199,000 BTU) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x$ 2.00 $ Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ ROUGH FIgAL Dept. of Bldgs. Phone 560-3450 City of Fridley: The undersigned hereby makes application for a permit for the work herein. specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. 0 Fridley, M Owner Kind of Building ��� Used as ez 4 ®/� To be completed about ����/�� X40 Estimated Cost, $ Old --& Building Permit No. Permit No. ;26? DESCRIPTION OF WORK HEATING or PO team, Hot Water, arm Air No Trade Name ��� , z� Size No Capacity Sq. Ft. E.D.R.BTU P. Total Connected Loa wl , ,g Kind of Fue BURNER —Trade Nam e�� Size Capacity Sq. Ft. E.DR BTU H.P. (REMARKS -OVER) "Y N. WELTER HEATING CQ Signed 4637 CHICAF-4® "9- MINNI"MUS 7, MiNNElS®T,# By CQgO.4P Business Phone No- ®�A/5 HOUSE HEATING TEST RECORD a j ADDRESS` APT. F OR CIT,r, S RB OCCUPANT OWNER„ 9 HEAT LOSS DATE HTG. INST. GAS CO. METER BAaW # SOLD BY INSTALLED BY Electrical Work By Gas tine By loe TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER � GAS DES N,, MAKE MAKE Model Model SerialMax. INPUT MAKE Model OF BURNER BTU Rating— OF FURNACE CONTROLS 9-V THERMOSTA at PIYent Size 40.4 a Valve KIND.OF LINER ZE—NONE Limit " Draft Hood _, _Regulator Limit Setting Filters Size Number Fan Setting Chimney Location Inside �"'�� Outside Pilot Type's Chimney Construction _ Pilot MakeIV sa Pilot Model Smoke Bomb Wiring Pilot Timing '' �/ Draft a` Test Tog L.W. Cut Off Door Pressure Pressure �� da Percent CO Date Tested _Z"" _ Input CFH �.�� Percg 602 mpany Testing Stack Temp. Percent CO Name of Tester Form 235 Lighting Inst. `"ter sue.lEcr PERMIT NO. City ®f Fridley - F AT THE TOP OF THE TWINS PERMIT BUILDING r ` ^.RECEIPT NO-' COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. �� r 1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 JOB ADDRESS 5775 Washington Street NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. Pt 9 & 10 1 Adams Street Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Marsha Romanchuk 5775 Washington St NE 574-9458 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Exterior Design Service 6391 Monroe St NE Fridley - 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION [j REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reside Dwelling 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. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. 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 $4,450 $2.23 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIO OF ANY OTHE ST E OR LOCAL LAW REGULATING CON• $ 72.00 Fire SC $4.45 STRUC ORT PERF M CE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE - License SC $5.00 $83.68 PER VALIDATED THIS IS YOUR PERMIT SIGNATU EOFC GTO ORAUTHORIZED AGENT IDATEI, SiGNATURE OF OWNER IIF OWNER BUILDER) (D ATE) BLDG INSP DATE NEW ADDN ( j CITY OF FRIDLEY ALTER f j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address:' 7t� Legal Description: Owner Name & Effective 1/ 1 /94 Tel. / MN LICENSE # r Address: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 GARAGE AREA: Length DECK AREA: Length . OTHER: S 0 Width Height Sq. Ft. Width Height Sq. Ft. Width Hgt/Ground Sq. Ft. Comer Lot [ ) Inside Lot [) Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated . Cost: $ Approx. Completion Date: Zo 97 `f (cost on Back) Driveway Curb CutWidthNeeded: Ft. + 6 Ft = Ft x $ _ $ DATE: ' /2 -`'/ APPLICANT: Tel. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ 22. c $ 4 CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $800 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $.� 0 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 $15 (Minimum Fee is $15 plus surcharge) $501 to $2, 000 $15 for first $500 plus $2 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $45 for fust $2,000 plus $9 for each additional $1;000 or fraction thereof, to and including $25,000 $25;001 to $50,000 $252 .for first $25,000 plus $6.50 for each additional $1;000 or fraction thereof, to. and including $50,000 $50,001 to $100,000 $414.50 for first $50,000 plus $4.50 for each additional .$1,000 or fraction thereof, to and including $100,000 $100,001 to $500,000 $639.50 for first -$100,000 plus $3.50 for each additional. $1,000 or fraction thereof, to and including $500,000 $500,001 to $1,000,000'. $2039.50 for the first $500,000 plus $3 for each additional $1,000 or fraction thereof, to and including $1,000,000 $1,000,001 and up $3539.50 for the fust $1,000,000 plus $2 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 it has been constructed will be required before proceeding with the framing. SUBJE61 MIT NO. City of Fridley 31520 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. ' ------ 6 .7/.3 r 1 � PROTECTIVE INSPECTION SEC. 1 = � '---5 CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 10/25/00 JOB ADDRESS 5775 Washington Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 9,10 1 Adams Street Addition +; 1 SHEET 2 PROPERTY OWNER MAIL ADDRESS ;� � ZI :1 PHONE Maria Newman 5775 Washington Street NE X74-9458 3 CONTRACTOR MAIL ADDRESS �� ," ZIP sF-' PHONE _LICENSE NO _ M J Construction 8071 Rancher's Rd NE, Fridley, '',55432 785-8851, 20233970 4 ARCHITECT OR DESIGNER MAIL ADDRESS r ZIP �'. PHONE`LICENSE NO 5 ENGINEER MAIL ADDRESS y y ZIP ;'"` PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ' ❑ NEW ❑ ADDITION ,% ❑ ALTERATION ,Y RgOAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK /" �"' �V, � Repair Siding 4" 9 CHANGEOFUSEFROM y TO STIPULATIONS" z��'47 97 niform Building Codi, requires that a weather Per Section 14�6-2, 19resistive barrier be plated over eterior,,�sheathing to protect the interior wall covering. Exceptions"'dor thi,fprovi4i on would be if sheathing is an approved weatherproof panel or when the:siding is an approved weather barrier. Vinyl siding is not a5,FweatheJ,�proof covering unless the manufacturer states this in their applicati6n guidelines. Call for inspection of wrap before covering. � SEPARATE PERMITS ARE REOUIRED 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 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 $2,060 $1.03 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT s DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SA9FPHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $83.25 25 a SC $2 .06 `Y 'RUCTION OR TH PERFORMANCE OF CONSTRUCTION PLAN CNE TAL FEE ® 7CE Lice e $5 $91.34 S�GN.TU OF CON•RACTOR OR AUTNORIZEO AGENT i TES H P O Y VA ATED THIS IS YOUR ERiAWW % B G INS!6AiE S.GNATURE OF OWNEROF OWNER BUILDER. iDATE, NEW [ ] Effective 1/1/2000 ADDN [ ] - CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: 57 7,57 w)aS � VI A�07— C- j &J, Legal Description: Owner Name & Address: Mow « NSA Tel. # S 7 '9 ZLo Contractor: M:I-- MN LICENSE # 202-3-3S70 Address: c5071 gaw,- wj 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: Construction Type: A kA Estimated Cost: $ C) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $. DATE: � 107,�/00 APPLICANT: -�I Tel. # :Z fS —6b- CITY 6b- CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ c(3.Fee Schedule on Reverse Side Fire Surcharge $ �-C, 6c, .001 of Permit Valuation (1/10th%) State Surcharge $ A0.3 $.50/$1,000 Valuation SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee $1100 per SAC Unit $ S --c-)6 $5.00 (State Licensed Residential Contractors) "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] `te][04 STIPULATIONS: $ 91 BUILDING PEMM 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 Iry $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 $23.25. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. New Houses Only i sue.iE�T PE City of Fridley 2-�il AT THE TOP OF THE TWINS BUILDING PERMIT COMMUNITY DEVELOPMENT O1Y. RECEIPT NO. r PROTECTIVE INSPECTION SEC. t NUMBER REV DATE PAGE OF A0POOVED BY = CITY HALL FRIDLEY 55432 612-571-3450 910-F15 10/15/01 JOB ADDRESS 5775 Washington Street NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. Pt 9, 10 1 Adams Street Addition SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Richard Neuman 5775 Washington St NE 763-574-9958 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Lindstrom's Cleaning & Const 9621 10 Ave N, Plymouth, MN 55441 763-544-8761 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 O NEW 0 ADDITION D ALTERATION REPAIR O MOVE O REMOVE B DESCRIBE WORK Reside one side of home 8 CHANGE OF USE FROM TO STIPULATIONS Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive barrier be placed over exterior sheathing to protect the interior wall covering. Exceptions for this provision would be if sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in their application guidelines. Call for inspection of wrap before covering. 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 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCE GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER ECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,060 $1.03 DOES NOT PR ME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS F ANY T R STATE OR LOCAL LAW REGULATING CON- SC $2.06 STRUCTI N R HE F RMANCE OF CONSTRUCTION $83.2.5 Fire PLAN CHECK FEE FEE TO7$91-34 License 5.00 SIGNAT FCONTRACTORORAUTHORIZEDAGENT IDATEI N P OPE IDA E THIS IS Y UR PERMIT T ,BLDG INSP - gAiE SIGNATURE OF OWNEROF OWNER BUILOERI IDATEI i NEW [ ] Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY .(763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: %�5^ `y�3�� Ael Legal Description: Owner Name & Address: lk/ lzj Tel. #a:a Contractor. Z-7 4-1V ! " ? MN LICENSE # Zn k ;7 Address: 94?., lD°�/h� ��rr�.7�- S� � Tel. #(.7 -5W-6;'-7e< 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: DECK AREA: OTHER: Length Width Height _ Length Width Hgt/Ground Sq. Ft Sq. Ft. Construction TypeZ Estimated Cost: Driveway Curb Cut Width Needed: Ft. + 6 F Ft x $ _ DATEVA l5 ® APPLICANT: Tel. #-2 —J-97-6,- CITY 6i CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ 0 Fee Schedule on Reverse Side Fire Surcharge $ ;2-06 .001 of Permit Valuation (1/10th%) State Surcharge $ /0-3 $.50/$1,000 Valuation SAC Charge $ $1150 per SAC Unit License Surcharge $ .S--00 $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 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 $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. New Houses Only InspectionsRESIDENTIAL, OCCUPANCY 'TYPE APPLICATION S a-5 Received By: �� P 763-572-3604 $ CITY OF FRIDLEY Fire Surcharge $ 3_ (.3 Date Recd: DATE (0-0 ,' .V.. ,. E-MAIL ADDRESS .... ........ . ............ .. ... ... v� SI IL: AL)ORNSI5�"7 4 SAC Charge $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ - _....=--YOUR 'PHIS APPLICANT IS: © OWN �CUN•1RACl'OR $450 Conservation Plan Review Park Fee ?ROPERTY OWNER/ NAM tr ` Sewer Main Charge $ TENANT ADDRESS S? %�i'S�f1, ... .. 5• _ GITY^ $ !] STAT I IP 2 PHONE� 4_► -- CONTRACTOR SUBMIT COPY OF STATE, LICENSE 9-1 , EXP DATel !7 _-._._...._........•. 41»��1 L�ZIi YOUR STATE LICENSE ADDRESS: v D , c' STA ; WITH APPLICATION PHUN •-5 FAX — b PROPERTY TYPE D SINGLE; PAMII,Y/NF,W CONSTRUCTION SIZE ❑ TWO FAMILYMEW CONSTRUC PION STORIES PERMIT TYPE ❑ ADDITION d GARAGE/SHED 1N1:)OWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK 13SIDINU ❑ OTHER ❑ SWIMMING POOL TYPE OF WORD:O NE'W 13 ADDITION TENANCE/REPAIR O REMODELING DESCRIBE WORK BITING DONEJ!�61&' W U1dOLt� SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SOUARSS ❑ HOUSE & UARAUH BASEMENT REMODELING §@JW'; 6AAAM "" ' © NITACHED GARAGE 1, 2• Existing Pl(uu flan Proposed floor plan PROPOSED SIZE: PROI'C)SEU HEIGHT: O DETACHED GARAGE 1. List of structural members to be used SIDnV(. POR NEW CONSTRUCTION INCLUDING DECKS, O Vinyl C]Sotfit APD11•OISS, & WRCHFS SQHMIT: ,Aluminum 11 Trim 1. Sita Plan/Suryey showing the existing structures 1 Q fluter .s 0 Fascia and pioposcd prtdcel• WINDOWS 2• Two sets of construction plans IN EXISTING OPENINGS ©No LOC:ATI N OF WINDOW G. 3. Energy Calculations i OR FOR NEW OPENIN62-_DF.scwti2 SILlr OF �,� 4j" y� OPENING CHANGES &'! TYPE' OF WINOOW TO DE INSTALLEiD14 *S1l4*tk S NUMBER OF WINDOWST pr7 J .4.1 ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.&C FEE SCHEDULE) TOTAL JOB VALUATION $ -5 U t- OCCUPANCY 'TYPE Permit Fee S a-5 See Back Page for Fee Schedule Plan Review $ 6510 of Building Permit Fce Fire Surcharge $ 3_ (.3 .001 times the total job valuation Surcharge . $ .0005 x. Permit Valuation Minimum $.50 License Surcharge $ 5'-c $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ Q + 6 ft W ft x $21 Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Neeossary ( ) Total Due $ !] Make checks uavable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROC ESSIZ �c I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be is c�nformanee 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 fur 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 all work vffich require view a d approval of plans. SIGNATURE OF APPLICANT PRINT NAMI�A ie, Ir0 Jl� DATE 4 ^ G Zd wuov : BT 9002 90 'unf L -BFT TZS£9L.: 'ON Xtid ha l p t ad fo 61!0: WONH