PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N°: 5 4 s s:9
Date:
Owner: BuilderlKo�e,-Z. 4F.I APE f -
Address — _ _ Address
LOCATIq1NF BUILDING
No.. �. _ Street � Part t _
Lot __ Block / Addition or Sub -Division
Corner Lot _ ____ Inside Lot d"'� Setback—*de'
. deyard ---4y-&
Sewer ElevationFoundation Elevation
DESCRIPTION OF BUILDING
T e Used /�
Front Depth`' Height_ Sq. F't. �(rSL� Cu. Ft/r- I C
Front Depth t Sq. Ft. Cu. Ft.
Type of Constructio _ Est, Cosh __ 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 d'ty of Fridley. x
In consideration of the payment of a fee of $� , permit is hereby granted to
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota l�regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violgMp of any of the provisions of said
ordinances. -.—t 1 d
7
NOTICE:
This permit does not cover the Construction, installation for wiring, plumbing, gas heating, sower or water. Be sure to we
the Building laspamp for separate permits for thea items.
Otiner I a
Address
APPLICATION FOR BUILDING PERMIT
CITY OF FRILLEY, MINNESOTA
NameA Builder t t
/V Do Yn A
3 , DQ,�r Address 1 "�"
7A A
LOCATION OF BUILDING
C�.
No.,C1 5 6Street p Prof Lot
r rr
Lot S� Block .�_ Addition or Subdivision
Corner Lot Inside Lot Setback_,J�_—:Side-Yard
SEWS'. ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
To b,66) used
DESCRIPTION OF BUILDING
z
Sq. Ft. / ® '� Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft
Type of ConstructionEstimated
To be Completed - ---
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 he facts and representations
stated in this application are true and correct.
DATE -- SIGNATURE
(A Schedule o/Fee Costs can be found on the Reverse Si fa -tom 7
1
105
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME IPM J� BUILDER
ADDRESS 40,�'O .
T. A. C ADDRESS
LOCATION OF BUILDING
NO QJ STREET 3 7/-J PART OF LOT
LOT BLOCK ADDITION OR SUBDIVISION
CORNER LOT INSIDE LOT SETBACK ISSIDE YARD
SEWER ELEVATION FOUNDATION ELEVATION
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:
r���� _ Front �, DepthHeight ��
Sq. Ft. IIJPI, Cu. Ft.
Front Depth Height
Sq. Ft.
Cu. Ft.
Type of Constructionr
_ �,�,ahLr Estimated Cost
To be completed
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE_ jX � � �9 sS
(Schedule of Fee Costs can be tound on the Reverse Side).
U
ier
•
. • . 0
City of Fridley
SUBJECT
PER
!i51
AT THE TOP OF THE TWINS
PERMIT
BUILDING
NO.
• COMMUNITY DEVELOPMENT DIV.
r �,.------,
INSPECTION
;RECEIPT
PROTECTIVE SEC.
r 9�l
1
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
,'J
`--•- 612-560-3450
910-F15
6/15/78
JOB ADDRESS 6050 - 5th Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4,5
3
Hyde Park
SHEET
2 PROPERTY OWNER MAILADDRESS
ZIP PHONE
Barney B. Buss 6050 - 5th Street N.E.
571-6222
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 El REMOVE
B
8 DESCRIBE WORK
Construct a 30' x 14' Addition to Back of House
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide anchor bolts as shown on plan. Provide City with copy of truss
design by July 6, 1978. Provide pre -formed galvanized valleys. Provide smoke
detector.
WARNIAll
NG
SEPMATE PERMITS REQUIRED FOR WIRINGBefore
digging call local utilities
NEA71K. PLUM' SING AND SIGNS.
TELEPHONE - ELECTRIC . GAS Etc.
REQUIRED BY LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame
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
420
4200
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
I
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
$10,718
$5.36
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.
$8.80
NONE
PLAN CHECK FEE
TOTALFEE
9
1 $16.36
SIG TUREOFCONT CTO R AUTHORIZED AGENT (DAT )
WHEN PRO ERLY THIS IS YOUR PERMIT
BLDG IN SP
^V^ALIDATE�D
DATE
IGNATUR F OWNER IIF OWNER BUILDER) .1 ATE) Da -I
J
Applica.i',t: atLuCl, tU this .form `1100 LC,'t: .'i.t ilt;r"^of Lli.JC?}� of Lot and prOn-sed
bu)-il(Ling .i.ocat.i.on d.rir.:an on t:'ese cer.t:i.ficatc:.;.
DESCFI PTI OIN OF BI.1I LD NG
To Be Used As:
�"A/7!L y iCvcar7 Front: Depth
Sauare Feet:
iX►Q% �x% _� Front: ��' - Dc.pth.
' Fie? ght:. .% Z
bic Feet:
Squa)-e feet. 1619 Cubic Feet...'
11}rpe of Construction: WO 0,p _ Estimated Cost: $ --.
To Be Completed:
.�_.. hit. 71. Alt:. R
/X
Prdposed 13riveway Width If New Opening Is Desir ea. ' � ,r^~!�- $�^�__
`SEE REVERSE SIDE OF SHEXT)
The undersigned horeby makes appl is iti_on for a p ers:li_t: for the work herein
specifi.cd, alreci_ng to do illi work in strict accordance wit -.11 the City of
Fxid.loy Ordinances and rul.LigS of the DCOZIrthuert Of FuildillgS, and hcreby
declare; that all. t1^ facts and represell tilt ions st; t:*gid in 01is application
are true and cor -ect. Sen reverse Sidi: f a6ditio_ :)l infor,iaLion:
DATE: �i %3 ? P - SIG IATURE;
- - r
s•tipulatioils: $.
6
1" frl:(...v
10I T y iii
APPLICATION 1701?
I31J
1 I_D % f -1G PERMIT'S et#j
Cf y
EW A''L I I�'A
T S,AC.1}I 1:ISS,
Ri..PAI IkS)
4gm y -_S .'8 5
J - I3U7LllI.':::
®�� s -;rd �:' ��t
1lLMY-css,
6 iq5�o_3 7l1
Tel. No.
(oS o
C
J % `
)r'c.
street.
�7
LOT:
� BLOCK:
ADDITION:
CORNER LJJ': INSIDE
LOT: SETi3nCY.:
SIU:BYr:f.DS:
Applica.i',t: atLuCl, tU this .form `1100 LC,'t: .'i.t ilt;r"^of Lli.JC?}� of Lot and prOn-sed
bu)-il(Ling .i.ocat.i.on d.rir.:an on t:'ese cer.t:i.ficatc:.;.
DESCFI PTI OIN OF BI.1I LD NG
To Be Used As:
�"A/7!L y iCvcar7 Front: Depth
Sauare Feet:
iX►Q% �x% _� Front: ��' - Dc.pth.
' Fie? ght:. .% Z
bic Feet:
Squa)-e feet. 1619 Cubic Feet...'
11}rpe of Construction: WO 0,p _ Estimated Cost: $ --.
To Be Completed:
.�_.. hit. 71. Alt:. R
/X
Prdposed 13riveway Width If New Opening Is Desir ea. ' � ,r^~!�- $�^�__
`SEE REVERSE SIDE OF SHEXT)
The undersigned horeby makes appl is iti_on for a p ers:li_t: for the work herein
specifi.cd, alreci_ng to do illi work in strict accordance wit -.11 the City of
Fxid.loy Ordinances and rul.LigS of the DCOZIrthuert Of FuildillgS, and hcreby
declare; that all. t1^ facts and represell tilt ions st; t:*gid in 01is application
are true and cor -ect. Sen reverse Sidi: f a6ditio_ :)l infor,iaLion:
DATE: �i %3 ? P - SIG IATURE;
- - r
s•tipulatioils: $.
6
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Page 1 of 4
EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION I t L
O
OWNER:zG/; �� "//Z_ DATE.
-71
SITE ADDRESS: OS -0 '5 .Si PHONE:
CONTRACTOR:
Determine working square footage of eacher '11400,v
1. Total exposed wall area...... sq. ft. x _
LLAIML
2. Total roof/ceiling area ...... sq. ft. x _.0@5_0'_ _
Total exposed wall area above floor—
a.
loor=
a. Total wall window ea.. _J q, / so. -0-
b. Total door area ..••...................... _ p
C. Total sliding glas door area ....................... gQ Sp. FT
d. Total fireplace wal ea ............................. !Y4LA
e. Total wall framing area (average 10%) .................. 374, .f so. it•
f. Total rim joist area .................................. 4 t.3/
g. wall area above floor ..........................
h. wall area above floor .......................... '
i. wall area above floor ..........................
j. wall area above floor ..........................
Total exposed foundation area =
k. Total foundation window area ............... .......... N A
1. Total net foundation area above grade .................
Determine "U" value of each wall segment
(e.g. window, door, each separate wall section)
a. 3y x ..U.. . /7
„S� _
b. X
c . 7v X
d. X
e. 5o• & X
f. S X
9- ""�� X
"U"
nun
&lull
llutl
_
"U"
h. X "U" _
i. X "U" _
j -
X "U" _
k. X "U" -
1. X loull
3 . ............................. Total
J't
If item #3 is the same as,
or less than item #1, you
have met the intent of
SBC GOOG (c) 2.
10
`acterior Envelope Average "U" Computation
Total exposed roof/ceiling area =
Page 2 of 4
m. Total skylight area ............................
n. Total roof/ceiling framing area (average 100)...
o. Total net insulated roof/ceiling area...........
Determine "U" value for each roof/ceiling segment
M. X "U" _
n. X "U" _
o. X "U" _
4 ........................... Total =
If total of #4 is the same as, or less than #2, you have met the intent of
SBC 6006 (c) 1.
Alternate Building Envelope Design
To utilize the total envelope system method, the values established by the sum of
items #3 and #4 shall not be greater than the sum of items #1 and #2.
1. + 2. _
3. + 4. _
WALL SECTIONS
NOTEa Use 10% of opaque wall area for
frame construction
FRAME WALL
4
06
1G. #3
Page 3 of 4
Construction IR -Value
1. Interior air film 0.68
2 • I v �� SH �TRoG Ic
3. 2x4
4 • 3�4 Slit BATH/NC-
5.
6. Exterior air f ilm 0,17
Total
1. Interior air film 0.68
2. y 'J sHF� SRocK — -
3. �ilta�ci„s
4. ms/µ sNl:ArRdN4
5• L n INsuL.ITF S/D/14Ci
6. Exterior air film 0.17
Total
, L01
1, Interior air film 0.68
2• _ a F/f&n gj,
3. ,/()'
4. �Y ' Se1EA-"A4'a q —
5. 't'" /7vSH4./T1 -g/b/j.+C-
6. Exterior air film 0.17
Total
1. Interior air film 0.68
2.
3.
4.
5.
6. Exterior air film 0.17
Total
I Y4
FId. #4 r 1l//
M Op r
NOT)i: Indicate type, "R"'value, depth and
placement of insulation.
4
•
• ROOF/CEILING
rflil(�I,�l i1�Cl
Vented heat flow
up
FIG. #r5
Page 4 of 4
Construction
R -Value
1.
Interior air film
-0.61
2.
y SNEFT nacic
`�
3•
Fir�En stns tNs�ntny�ort
/CZZ
��
4.
Exterior air film (still)
•0.61
Total
"L Lt
1. Interior air film 0.61
2.
3.
4. Exterior air film (still) •0.61
Total
Heat flow up ;Vented•
- -FIG. #6-. 1. Inside air film
2.
3.
4.
r�.Gu�t�= ;`�"; , •.� 5. Outside air film
0.61
0.17
Total
Note: Use additional sheets if more space is
needed for details and calculations
' rcuc:-v1:1V1Y:U •
Heat
Flow up '.
fPT.r. *7
J
SUBJECT
City of Fridley
(:?
3 � � 2 '
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
' '
� • _ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
(�
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
8/11/95
JOB ADDRESS 6050 5 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4,5
3
Hyde Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Barney Buss 6050 5 Street NE
571-6222
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 Ij ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace picture window with Bay window
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
]
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
500
.50
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$21.00
Fire SC .50
PLAN CHECK FEE
TOTAL FEE
22.00
S TURE OF CON�-RACTQ40RAUTHORI DAGENT *TE,
NPE VALI ATED THIS IS YOUR PERMIT
/L:A4
B G INS.?
C
gaTE
SIGNAT RE OF OWNEROF OWNER BUILD I ATE]
J
U
_FbR_ AJ)Dl.TI-O 1
I
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—1
NEW [ ] Effective 8/1/95
ADDN (] CITY OF FRIDLEY
ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application =8OG(b
Construction Address: �-, 0,5-0 S d Sr- IV � /5 /J/ L E y , AN
Legal Description:
Owner Name & Address: ,yz lre v lS�.ss Tel. # S`il -6 )- 2- 2 --
Contractor:
Contractor: !V A _ MN LICENSE #
Address
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
'LIVING AREA: Length' Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width / Hgt/Ground Sq. Ft.
OTHER: �T 111JO/JL* J�/i E/11 /G 64/•$ [� Gv W OykBG�' Vaw IVIAWt�d 9
eo/alpI ca, /L n Tho it
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction:j x e -
Estimated Cost: $ 3Z6 `: --V
Approx. Completion Date: 0,-7 1'5 %S
(Cost on Back)
Driveway Curb Cut Width Needed: —
DATE: APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
c�
Ft. + 6 Ft =
Ft x $
Tel. #
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1110th%)
$.501$1,000 Valuation
$850 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 [ ]
1 . -W-s
J
SUBJECT
P
City of Fridley
3 3 0 3 4
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT
`� COMMUNITY DEVELOPMENT DIV.
__ ___
r � � � PROTECTIVE INSPECTION SEC.
1 �
NUMBER
REV
DATE
PAGE Of
APPROVED BY
� CITY HALL FRIDLEY 55432
763-571-3450
910415
9/3/02
JOB ADDRESS 6050 5 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4,5
3
Hyde Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Barney Buss 6050 5 Street NE
763-571-6222
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Same
a 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 jJ ADDITION O ALTERATION O REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Construct an 8'3" x 5'7" front portico
9 CHANGEOFUSEFROM
TO
STIPULATIONS
See notations on plan.
WARNING
Before digging call for
all utility locations
4540002
REQUIRE® BY LAW
SEPARATE PERMITS ARE REOUIREO 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
1 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
$1,028
$.51
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-
41.80
Fir SC $1.03
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN
TOT L�FEE
!H�ECKE
43.34
S�GNA OF CON' �gCTO R AUT j0ZEO AGENT [DATE,
HE PRO VALID THIS IS YO PERMI /)
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�GNATuaE v OWNER, -F OWNER Bui iDATE.
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NEW [ ] CITY OF FRIDLEY Effective 1/1/2002
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 5723604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
TN u'
Construction Address. 60 S -7A ST IV, r9l Z
Legal Description: _J
Owner Name & Address:
Tel. # 763 S-71 - 6 Z L 1 -
Contractor. J75- I- r 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 IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft
GARAGE AREA: Length Width Height Sq. Ft
DECKAREA: ngth 8 / J Width X %J� Hgt/Ground ZZ A/ Sq. Ft 149
OTHER: b'�0A, &AAP66B
I
Construction Type: 4)0" Estimated Cost: $ o0p, 5
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $
DATE: 81L112-001- APPLICANT: �i a Tel. # 70- J-2 -- 6 L.I-)-
11 1
Call (763) 572-3604 for Permit Fees if mailing In appl cation or Fax to 763-571-1287 if using credit card and we will
call you for card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 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 [ ]
STIPULATIONS:
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ENGINEERS AND SUPMEYORS
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Building
BUILDING
Permit No.: `"--
Inspections
RESIDENTIAL APPLICATION
OCCUPANCY TYPE
Received By: .�
763-572-3604
CITY OF FRIDLEY
Plan Review
Date ec'd
65% of Building Permit Fee
Fire Surcharge
DATE D YOUR E-MAIL AD S
DOI times the total job valuation
SITE AD
$
0005 x Permit Valuation Minimum $.50
License Surcharge
THIS APPLICANT IS: ❑ OWNER OCONTRACTOR
$5.00 (State Licensed Residential Contractors)
PROPERTY OWNER/
NAME:
$1550 per SAC Unit (Pians to MWCC for determination)
ADDRESS: S 'I /Fi CITY
STA IP
TENANT
Erosion Control
PHONE: _571—
$450 Conservation Plan Review
CONTRACTOR
NAME: Cedar Valley Exteriors Ip
Fee Determined by Engineering
STATE LICENSE # 20630613 EXP DATE 3/31/2008
$
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: 1700 93rd Lane ne CITy 61a1ne STATE mn;MB ,55449
WITH APPLICATION
PHONE 7637552221 FAX 7637555390
PROPERTY TYPE
O SINGLE FAMILYINEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRU ON STORIES
PERMIT TYPE
❑ ADDITION AXUARAGEISHED ❑ WINDOWS
0 BASEMENT FINISH JWOOF ❑ DRAIN TILE
C3 DECK OSIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
O NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ M42DELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT LENGTH WID
HEIGHT Sq. Ft.
ROOFINGUSE ONLY
NUMBER OF SQUARES �� OUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGES ❑ ATTACHED GARAGE
1 •
2.
Proposed Floor Plan
Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
O Vinyl ❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim
1.
Site Plan/Survey showing the existing structures
O Other ❑ Faso
and proposed projea
.M
2.
Two seta ofconstruction plans
IN EXISTING OPENINGS OYes ONo LOCATION OF WINDOWS
3.
Energy Calculations
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. E 1PR7
U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $
OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
DOI times the total job valuation
Surcharge
$
0005 x Permit Valuation Minimum $.50
License Surcharge
$^t (�
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1550 per SAC Unit (Pians to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21= $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
Make checks uavable to: City of Fridley 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 perrnit an ork i of to s rt without a p t; th#t th wil.>rb� in accordance with a approved
plan in the case of all work which equi>L re 'e d pr a f plans. h 7 I7'y
SIGNATURE OF APPLICANT 7 NAME DATE