PRE 2010 DOCSCity of Fridley, Minm..
BUILDING PERMIT X® C4i_2ff'*)
Date:
Owner: Builder W
Address ....._.._.._.....__._�. _.. Address +-h�:_.._ Y._..._..:.
OCA OF BUILDING
No. ....&./--------. Street _. _ .: ....:, :`,[ -x._-• r^....._...-._.... Part of Lot
Lot ..... -....__..._... Block ............. :..................... Addition or Sub -Division
Corner Lot ............................ - Inside Lot ----- -' "........... -........ Setback ... ...................... ideyard ..... o. .........
: .........................
Sewer Elevation ...... _..... _.................. _.._......._......._...._.._.._.._...__ ..._.._.._ Foundation Elevation
DESCRIPTION OF BUILDING
To Used as:
Front ... .:.. r4.._.. Depth .: ,, Height .. .... Sq. Ft. r Cu. Ft. O �!��.Cr,r�
........ Front .. .', _.. Depth .. Height ..... .... Sq. Ft. Cu. Ft. ...3..�f �.10
Type o Construction ... :f ..... Est. Cost ! ,? ,,.� .....`....... . To be Completed ............. ................. ..........-........
CAUTION
THIS PI'aP�-;cr r�vr a oRI.�E Yt�.AT
ION OF- AN)'' ,L ti,:D'�
BUILDING12ES'TRIC7IVNS, OolNA,itiSSAWD
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 city of Fridley.
._..............
In consideration of the payment of a fee of $. ... W.._..._._...., 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
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. _" ' .a 1.1
�'•..� Building Inspector
NOTICE:
This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sower or water. Be sure to see I
the Building Inspector for separate permits for these items.
_ 4 •
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY. �MINNESOTA
Owners Name ?0--f Builder. der
Address Address
LOCATION OF BUILDING
e125
No. 6-__-A Street Part of Lot
Block
2= Sub.Div. ewg &
Lot Addition o�
Corner Lot Inside Lot
_,,g�Set Back Side -Yard
SEM ELEVATION FOUNDATION ELEVATION
Applicant attach to'thisi-form Certificate of Survqy,of Lot acid proposed -building
location.
DESCRIPTION OF BUILDING
To be used as:
Depth jv"� - �.Height _,2_0_.O
N
Sq. Ft. Cu. Ft.
/9* Rai 1711+
Sq. Ft. Cu. Ft.
Type of Construct -ion 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 Ordiminces and ruling of
the Department of Buildings, and herieby declares that all the facts...,and representa-
tions stated in.this application.are true and correct.
DATE )ex
SIGNATURE
'(A'Schedule of Fee.cpsts can be found on the Reverse Side,)
City of Fridley ,
Application for Plumbing and CT= Fitting Permit
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures Location
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE TOTAL
Number Fixtures ...................
Z
;�
$ o
Future Fixture Opening ................
a
x
5
�
New Fixture Old Opening ..............
i
z
+
F
`
N
WATER HTR.
GAS
ELEG
x
3.25
$
2.00
00
u,
C�+O
V
<
(�9•d
�a4
�O
x
3.25
$
GAS FITTING FEES:
NO.
RATE TOTAL
$ Z"S d
1st 3 Fixtures ..........................
x
$1.50
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
Base
x
2.00
$
1st
f
2nd
_
3rd
_
4th
• Future Connection Openings
Connected withI Sewer
New .Fixture, Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE TOTAL
Number Fixtures ...................
x $1.50
$ o
Future Fixture Opening ................
x
1.20
$
New Fixture Old Opening ..............
x
1.00
$
Catch Basin ............................
x
3.25
$
2.00
00
$�
Water Heater (Up to 200,000 BTU)
......
x
New Ground Run Old Bldg. ............
x
3.25
$
GAS FITTING FEES:
NO.
RATE TOTAL
$ Z"S d
1st 3 Fixtures ..........................
x
$1.50
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$,
TOTAL FEE $. % •fo
City of Fridley:
4
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.
Fridley,
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $ y �"
Old—New. Building Permit No ,- d- Permit No. *�
Signe
By
Business Phone No
ROUGH
FINAL
4z 2M 7-89
a . a
Application for Rawer Plants and Heating, Cooling, Ventilation, Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL,
Furnace Shell & Duct Work .......................... 8.00 $
Replacement of Furnace 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $—
MECIL WARM AIR 8�
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
reach add. 60,000 BTU ... _ � .................. 2.00 $ _
Replacement of Furnace ............................. #.00 $
Repairs & Alterations—up to $500.00 .... ............ 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. IDR Steam....... 8.00 $
a ,
e Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 a $
Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $�—
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x $1.50 $ �
5j
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $
ALTERATIONS & REPAIRS TOTAL FEE $
ROUGH
FINAL
Dept. of Bldgs. Phone SU. 4-7470
Locatfon b l (. ` �-y' 1;_1 � .
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.
Fridley, Minn a3 i9b v
Owner
Kind of Building1`�Y19�
Used as
To be completed about
Estimated 'Cost, $
Old—New Building Permit No.eA6;�_' Permit N
DESCRIPTION OF WORK
HEATING or POWER PLANTS --Steam, Hot Water, Warm Air—No
Trade Name Size No p a
Capacity! 9P -,'b o a Sq. Ft. E.D.R BTU H.P.
Total Connected Load � a � `� 5 Kind of Fuei
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS—OVER)
By J
4 2 2M 7-59 Business Phone No f� 3— 1 6
City of Fridley, Minn..
BUILDING PERMIT N? (:5::61:0)
Date:
Owner: Builder
"40�
Address Address
_VN0OF BUILDING
No. Street �,,.— P f Lot
Lot __ Block- r Addition or Sub -Division
Corner Lot .__ Inside Lot Setback
Sewer Elevation ____ ` Foundation Elevation
ESCRIPTION OF BUILDING
To
Front ' Depth Height Sq. Ft. Cu. Ft.
tIs
epth eight_ Sq. Ft. Cu. Ft.
Type of Construction, Est. Co y"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
,1.Z=
of the city of Fridley.
F
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 regardu► location, construction, alteration, maintenan pair and moving of buildings
within the city limits and this permit may be revoked at any time uponyidla-tioA of any of the provisions of said
ordinances. ,��""
ice...-. —23"'OT1
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be aura to we
the Building Inspector for separate permits for thew Items.
MINDER ENGINEERING CO., INC.
ENGINEERS AND SURVEYORS
LAND SURVEYING SOILS TESTING
CIVIL d. MUNICIPAL ENOINEERING LANO PLANNING
6418—SGTN AVENVE N.
MINNEAPOLIS 2T, MINN.
KE 7- 3637
C 2 Ilei 0 f i lC a 1i e of
SURVEY FOR Tare SILV I S
t, e
14t 9 — -- — -- —,1� IRON
I I
61
I � r
1n?cl; I
-�I
.LOT '2 F L I . '2'� � � � A�� � �. N � A..D D' N
WE HEREBY CIEUTIFY THAT T1415 15 A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF THE
LAND ABOVE DESCRIBED AND OF THE LOCATION OF ALL BUILDINGS, IF AMY, THEREON , ANO ALL VISIBLE ENCROACHMENTS.,
IF ANY, FROM OR ON SAID LAPID. MINDER ENGINEERING CO., INC.
DATED THIS DAYaF NQV• Ao.►�59
EN61A1 E" AN9 ;Um YOR
City of Fridley, YHnn.
BUR DING PERMIT
•
Date: JULY 10, 1965
Mr. Anderson
Builder
CHESTER GLISAN
1,;P-,97�1
8168
Address 6161 - 5th St. N. E. Adm 519 - 10th St. N. W.
Fridley 21, Minnesota New Brighton, Minnesota
LOCATION OF BUILDING
No. 6161 get 5th St. N. E. Part of Lot
Lot 26 Block 2 Addition or Sub -Division _ Uplands, 2nd Addition
Corner Lot _ Inside Lot Setback Sideyard
Sewer Elevation Foundation Elevation
To be Used as:
DESCRIPTION OF BUILDING
Front Depth Height Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Est Cost $7,500.00 To be Completed
• STORM DAMAGE REPAIRS
•
In consideration of the issuance to me of a permit to constru the building described above I agree to do
the proposed work in accordance with the description above set and in comp th a'l�l provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 10.00 permit is hereby granted to
SHKSTER GLISAN CO. to construct the building or addition as described above. This permit is granted upon
the express crondition 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 reg location, construction, alteration, maintenance, repair and moving of buildiaes
within the city limits aad�t permit may be revoked at any time upon violation of any of the provis�lons of d
ordinances.
ALLEN G. JENSEN Building Inspector
NOTICE:
Ab pemdt don not em m the cendmd1on, hwhdk w hr vdib , phimbEee, gas hatht% sewer or water. Be sun to sa
the BuNing hapomr for separate psuhs for tine Items,
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME
ADDRESS'—
LOCATION OF BUILDI
N0, STREET PART OF LOT
LOTCQ (,p BLOCK ADDITION OR SUBDIVISION
r
CORNER LOT INSIDE LOT SETBACK SIDE- ARD
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To be used as;
DESCRIPTION OF BUILDING
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction e�_r,.,.._-,�,sEstimated 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_ �-�— J SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
N? 51'75
Original Permit for PLUMBING AND GAS FITTING s -X s V3
N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for Fee t j
inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit., !o
DESCRIPTION OF WORN
Number, Hind and Location of Fixtures
,gtOrleB
m
E W
a 0
J
3 U
m
Q
Z
rc
7
M
Q 7
m F
m
m
Q
m
Z
F,
m
4 r
y
3 F
y �-
Z 7
E O
0 4.
m
w
O
x
y
C m
O Q
A K
LL 0
S m
F m
Q Q
U m
;
Z 0'
Q D
E-1
m K
f LL
m y
Q d
O Q
W
m 2
Q Q
O E
WATER HTR.
6A8
ELEC.
Basement
/
1st
2nd
3rd.
4th
Connected with Sewer -Cesspool Gas Piping for Openings
Permission is hereby granted to do the plumbing and
gas fitting in the building described in the statemendhereto attached, upon the express condition that
the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing
or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and
this permit may be revoked at any time upon the violation of any of the provisions of said ordinances.
By Order Of The Inspector Of Buildings
Roughing in Inspection Date
Inspector.
Final Inspection Date
Inspector.
.z inn—e.s9-v
City of Fridley % ,19-2-0
Owner 7� �9,Gir✓
Location (P / 10 N .
Kind of Building ��
Used as
To be Completed , 19
Estimated Cost $_ YOU Ld
Building Permit No.
Date
Inspector of Buildings.
City of Fridley
Application for Piing and Got Rftg Potek
Dept. of Bldos. Phone 580-3450
DESCRIP'T'ION OF WORK
Numbsr. Kind and Location of Fixtures
a
City of Fridley:
The .undersigned hereby makes application for a permit for the work herei
specified, agreeing to do 411 work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application arq-1?Ae and correct
Owner
Kind of
• Future Connection Openings I wsm Sower
* Nees Fixture, Old Openings Cesspool a Used as
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ................ x $2.00 $ 46
Future Fixture Opening ............ x $1.50 $
New Fixture 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 $3.25 $
Electric Water heater .............. s $2.00 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures x $2.00 ;
Additional Fixtures .................. x $ .75 $
Gas Range to 199.000 BTU .. ,.......... x $5.00 $
REPAIRS & ALTERATIONS—Rotor to Code
Description ............................................._
Q
TOTAL FEE
Fridley,
19LIO
To be completed about
Estimated Cost,
Old—New. Building Permit No. Permit No. c7
Signed
By -- -
Business Phone No
ROUGH
FINAL
SUBJECT
PE
City of Fridley
5 4 7 8
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIPT
� • COMMUNITY DEVELOPMENT DIV.
i 1 fr------
INSPECTION SEC.
�
r � PROTECTIVE
NUMBER
REV
DATE
PAGE OF
APPROVED BY
1 CITY HALL FRIDLEY 55432
!It---- %.j
t'--'11.�
612-571-3450
910-F15
9/8/97
10B ADDRESS 6161 5 Street
1 LEGALLOT
NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
26
2
Uplands 2nd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Ron Larson 6161 5 Street NE
572-0234
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 iJ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside House & Garage (Vinyl)
9 CHANGE OF USE FROM TO
STIPULATIONS Install building wrap and have inspection of same unless
manufacturer's specifications state it is not required.
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
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-
$
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$65.25
SIG URE OF CONT TOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERLY LIDATED THIS IS YOUR PERMIT
S.GNATUR OF NER iIF OWNER BUILDER) IDAT I
BLD INSP
BATE
NEW [ J Effective 1/1/97
ADDN [ j CITY OF' FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: !!�I6e
Legal Description:
Owner Name & Address: /ro." Z�? rZ5ok_% 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.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMEN' T
Length Width Height
Length Width Height
Length Width Hgt/Ground
4
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: j Estimated Cost: $ ac
(Fee Schedule on Back)
Driveway Curb CutWidth Width Needed: Ft. + 6 Ft = Ft x $ - = $
DATE: g- - 9 7 APPLICANT: Tel. #!S
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
iTIPULATIONS:
CITY USE ONLY
$ 12- 02 � Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$ /.00 $.50/$1,000 Valuation
$ $950 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 [ )
$
doe - —
City of Fr
Fridley27393
AT THE TOP OF THE TWINS
?RE
SUBJECT
BUILDING
PERMIT
r
I
' '
_ COMMUNITY DEVELOPMENT DIV.
v PROTECTIVE INSPECTION SEC.
1 � ,
CITY HALL FRIDLEY 55432
612-571-3450
NUMBER
910415
REV
18/25/98
DATE
PAGE OF
APPROVED BY
JOB ADDRESS
6161 51-h Rt—ept- N1?
1 LEGAL
DESCR.
LOT NO..
26
BLOCK
1 2
TRACT OR ADDITION
IU-Dlands, 2nd Addition
SEE ATTACHED
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Ron Larson572-0234
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Owner
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (28 S Tear -off
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
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
ZONING
SO. FT.
CU. FT.
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
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
VALUATION
$2335
SURTAX
$1.16
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
$74.75
Fire AC $2.33
PLAN CHECK FEE
TO E
7 .24
SIGNATU FCONTRACT RORAUTHORIZED AGENT (DATEI
PR P
ALIDAT HIS IS YOUR PERMIT
a
8LDG NSP
DATE
SSG ATURE OF O OF OWNER BUILDER) IDATEI
NEW [ ]
ADDN [ ]
ALTER [ ]
ConstructionAddress:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
Legal Description:
Owner Name & Address: Tel. # ;� 7�v 02�
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 04PROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Nyi0th Hgt/Ground Sq. Ft.
OTHER: C���
Construction Type: 7 a --y Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: a�J APPLICANT: Tel. # g % ,p ) 5 7P l
Permit Fee $ 2 S
Fire Surcharge
$
State Surcharge
$ /(0
SAC Charge
$
License Surcharge
$
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $ / , ) L
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 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 [ ]
3uilding
BUILDING
Permit No.: 6/9
-;6�
Inspections
RESIDENTIAL APPLICATION
Received By:
163-572-3604
CITY OF FRIDLEY
Date Rec'd:
)ATE /% '-- o 6V
— O S YOUR E-MAIL ADDRESS �Or Ul l r C®iil
ADDRESS tol6f
.S- 7114 sT
.ITE
'HIS APPLICANT IS:
'OWNER ❑CONTRACTOR
PROPERTY OWNER/
NAME: ,806 FEL®/GA`
ADDRESS: (o l CP P S- 7-# ST CITY ,24OL£Y
STATA�12 �
TENANT
PHONE: iv l d-- - ? O.Z - 1393
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIIA1MING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
ANCEJREPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: 'IREPL AGS F c1577,Vf- w l VD040S — 2T
AIAl L £ PE4
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
GOOFING
❑ HOUSE ONLY
DUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
1. Existing Floor Plan
3ARAGES
❑ ATTACHED GARAGE
2. Proposed floor plan
?ROPOSED SIZE:
13DETACHED GARAGE
3. List of structural members to be used
'ROPOSED HEIGHT:
^C S ` S Y (N C pc M`/j G s°
/ T fi
>IDING
�(G
FOR NEW CONSTRUCTION
INCLUDING DECKS,
ZI Vinyl
❑Soffit
ADDITIONS & PORCHES SUBMIT:
:1 Aluminum
❑ Trim
1. Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
N EXISTING OPENINGS
es ❑No LOCATION OFWS
JR FOR NEW OPENINGS- ESCRIBE SIZE OF MA11L �le£L
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED UI L tO NUMBER OF V4NDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MA'fk; anti:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 2 9PO, ® ® OCCUPANCY TYPE
Permit Fee $ 93 10157
Plan Review $
Surcharge $
Fire 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
(.0005) times the total job valuation — Minimum $.50
.001 x Permit Valuation (1/10%)
$5.00 (State Licensed Residential Contractors)
$1450 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks Davable 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 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 wh' u e review and approval of plans. �i
SIGNATURE OF APPLICANT J6 �.� PRINT NAME &Q F£L,-lG� DATE
I
C- e r)J26
Building
$
BUILDING
See Back Page for Fee Schedule
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
,2
CITY OF FRIDLEY
Fire Surcharge
Date Rec'd:
DATE //— /1-10
YOUR E-MAIL ADDRESS
License Surcharge
SITE ADDRESS 61 C
$5.00 (State Licensed Residential Contractors)
THIS APPLICANT IS:
[3 OWNER XONTRACTOR
PROPERTY OWNER/
NAME: / /
$
TENANT
ADDRESS:CITY agl
(_ STAT] i IP
$
' l
$450 Conservation Plan Review
Park Fee
PHONE:
CONTRACTOR
NAME: lwge X -
$
STATE LICENSE # OIVW F -d XP DATE �.� / - �O
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS:./ /�
..�
WITH APPLICATION
PHONE - a FAX
PROPERTY TYPE
SINGLE FAMILV4M9ft@==2RWON SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHEDWS
❑ BASEMENT FINISH ❑ ROOF DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCEMEPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: .S
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1. Existing Floor Plan
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
1. 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 es ONO LOCATION OF WINDOWS
OR FOR NEW OPENING -DESCRIBE SIZE OF 16�l �'.ir%% 11,�11G71( _S ZAE
OPENING CHANGES &
977f5�t�%
TYPE OF WINDOW TO BE INSTALLED
eAtNUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION
(USING T� 8) _ FEE OCCUPANCY TYPE
Permit Fee
$
/,,00
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Surcharge
$
,2
(.0005) times the total job valuation — Minimum $.50
Fire Surcharge
$
4 CJ
.001 x Permit Valuation (1/10%)
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $20 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
..�
Make checks payable 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 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 which a , 1� roval of plans.
SIGNATURE OF APPLICANT PRINT NAME G_ l/K- 1-e
ClCtGIr /
DATE �! / ��.Y—
s