PRE 2010 DOCSJ
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City of Fridley, Minn.
BUILDING PERMIT N° 3349
-s
Date.........1.......................... ....
Owner....................................... Builder ......... ... .... .... ....
Address ...................................... Address .........
....................................
DATION 08 DING
No. ...� Street .. 6..�........�:�:�: �t.. %. Part ................... ...........
Lot ..,g ..... Block ..... 7 .......... Addition or Sub -Division Wtu-oa.
.. .. .. .
Corner Lot ............ Inside Lot .. �....... Setback .. �� �Sideyard .. j0 -.7t-.0 .............
DESCRIPTION OF BUILDING
To,�e Us Y
, s �/ Cj
Q�'�// .. .... .... Front .. !. 0 !Qith R. 7i5� Height .. � . /.. Sq. Ft. �.9.6. 0. Cu. Ft.
(/
.................... Front ........ Depth ..... Height ........ Sq. Ft.......... Cu. Ft. ........
Type of Construction ... FRA04 J... that. Cos .7� r . �'�... To be Completed ...................
In consideration of the issuance to me of a permit to construct the buil g desribed above, I agree to do
the proposed work In accordance with the description above set forth an in compliance with all provisions of
ordinances of the city of Fridley.
....................................
In consideration of the payment of a fee of flv. '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 an work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
........ Building Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Item&
City of Fridley, Minn.
BUILDING PERMIT
Date:
f
Owner: ...... -._-.jj- t.. JT _. _ . .....:....... Builder
Address ........ ! ... __ _ _ Address
LO 10 F B,,yULNG
No. -?:.... Stt'eet _.5F'.. __.......... Part Lo
_......_......._... .._....._...._... _..... _
t �
Lot .....-................. Block...... _.....-.........
.._.............._ Addition or Sub -D _
f
Corner Lot ..... ............... __._........ Inside Lot ....._..---i ...... Setback . ` i e and ..... _......... ..... ..._.............__--------. - ------
Sewer Elevation ...... ....... _... _..................... ....... _... ............. ............................ Foundation Eleva on
DESCRIPTION OF BUILDING`'
T
710
.... .....W.:.. Front , .. Depth . . Height ......... Sq. Ft. t11. Cu. Ft., _
........................................... ---- _..------------ Depth... ei ht Sq. Ft....................... Cu. Ft. _... _.................
Type of Construction ...-A4_404 .. Est. t... y .............._..---... To be Completed ........... W ..... __......----
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 kr__..._._...., 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 tim po olation of y of the provisions of said
ordinances.
Building Inspector ,
NOTICE:
This permit does not cover the construction, installation for wiring, plum6lne, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
., 4 0
APPLICATION FOR BUILDING PERMIT
C TY OF FRIDLEY, MINNESOTA
�S / JBuilder
Name
Owners �y
Address / � ��� � � ` Address .5,
OF BUILDING
No.
Lot Block Addi
Corner Lot Inside Lot Set Back
%g Z Part of Lot
l %
or Sub.Div. o
A? Q /.
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
To use a
Front
Sq. Ft.L&Cu. Ft.
Sq. Ft.
Type o
DESCRIPTION OF BUILDING
Front Depth Height
f
Cu. Ft.
r'
Construction 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 Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts d representa-
tions stated in this application are true and
,dc� r at.
DATE SIGNATtA�E ,�
(A Schedule of Fee costs can be found on the Reverse Side.)
97-8)1-879001
CITY OF FRIDLEY
• APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
L
W
g
'J N
u
D
•'
MCJ�
qi°
N 3
a
Q
p)
u
8
egy
U
a
w
a
g
�gg'
u
QI
v
Water
Heater
as
lec
$2.00
$
-X
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTO
x
$5.00
$
100,000 BTU to 199,000 BTO
x
$10.00
lst
Water Softener
x
$7.00
_
$
76
4E
63
A
e.
x
$5.00
$
GAS FITTING FEES:
2nd
x
'$3.00
$
Additional Fixtures
r ng
a
d dryer
Gas Range to 199,000 BTU
x
$10.00
$
REPAIRS F, ALTERATIONS
First $100.00
3rd
$5.00
$
each add. $100.00 or fraction
$2.00
$
State Surcharge
$ .50
TOTAL FEE
$ 11.SQ
4 th
(P.) a Future Connection Opening
(t) - New Fixture, Old Opening
Connected with Sewer
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
Number Fixtures
ff
$3,00
$
Future Fixture Opening
x
$2.00
$
New Fixture, Old Opening
$2.00
$
-X
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTO
x
$5.00
$
100,000 BTU to 199,000 BTO
x
$10.00
$
Water Softener
x
$7.00
_
$
flew Ground Run Old Building
x
$5.00
$
Electric Water Heater
x
$5.00
$
GAS FITTING FEES:
lst 3 fixtures
x
'$3.00
$
Additional Fixtures
x
$1.00
$
Gas Range to 199,000 BTU
x
$10.00
$
REPAIRS F, ALTERATIONS
First $100.00
$5.00
$
each add. $100.00 or fraction
$2.00
$
State Surcharge
$ .50
TOTAL FEE
$ 11.SQ
REINSPECTION FEB
(S10.00)
Job Address 776 NE 63 Ave.
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. 8-24-78 , 19
OWNER SUND
KIND OF BUILDING frame
USED AS
TO BE COMPLETED ABOUT 8-2b-78
8
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
Company
Signed By M)NNEGASCO
Tel. No.
ROUGH INSP.
Date _
FINAL INSP.
Date
APPROVAL FOR PERMIT 2Z,
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCBARGE
• CITY OF FRIDLEY
- 97 -84 4 16051 •
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PARTIAL RATE
SCHEDULE
?LUMING FIXTURE RATES:
NO.
RATE
TOTAL
20umber Fixtures
x
$3.00
u
.
x
a�
$ '
Water
x
$2.00
a„
H
e n
x
$5.00
S
ro
x
•$5.00
100,000 BTU to 199,000 BTU
Heater
$10.00
a7
N
'
x
S
S
ttew Ground Run Old Building
C
{m�
Gl
w
M
8
$5.00
U
d
lee
J
C
..
S
K
I
M
VI
C
+1
�•
N
�� 1 a
w 0
O
.0
O
.-4
Bin
(a r
v in
a m
.w
O
U
a
,00
of
a•
e w
a
W
u M.0
3
T�
as
1dry
r
tid
.ti
(R) - Future Connection Opening
Connected with Sewer
(•) - New Fixture, old Opening
Water
PARTIAL RATE
SCHEDULE
?LUMING FIXTURE RATES:
NO.
RATE
TOTAL
20umber Fixtures
x
$3.00
$
Future Fixture Opening
x
$2.00
$ '
flew Fixture, Old opening
x
$2.00
S
Catch Basin
x
$5.00
S
Water Heater - to 99,000 BTU
x
•$5.00
$
100,000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7.00
S
ttew Ground Run Old Building
x
$5.00
$
Electric Water.Heater
x
$5.00
$
GAS FITTING FEES:
1st 3 fixtures x' '$3.00 $
Additional Fixtures x $1.00 $
Can Range to 199,000 BTU x $10.00 $
REPAIRS $ ALTERATIONS
First $100.00 $5.00 $
each add. $100.00 or fraction $2.00 $
State Surcharge $ .50
TOTAL FEE $ 8.00
REINSPECTION FEE
Job Address 776 63 Ave. NE
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. 3-7-79 , 19
OWNER SUND
KIND OF BUILDING frame
USED AS res.
TO BE COMPLETED ABOUT 3 -lb -79
ESTIMATED COST 30.00
OLD - NEW BUILDING PERMIT N0. PERMIT NO. /OnO
Company
Signed By MINNEGASCO
Tel. No.
ROUGH INSP. '
Date
FINAL INSP.
Date
APPROVAL FOR PERMITA61zg ,
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLUS $.SO STATS SM CIM=
tAlIiEFIA FfCaF[I
i .., a 'c,tr►. _ .e.-._..IT—
l.wrw
FRIDL.EY 119 = 24 = 14 ( NE' SE1 SE`
..I � .w. -a e�+..�\a.: 1ea�[b+..s ►r..� w.Y/.w. �0 a wr s^ �'w Lm. �r ",
776 63rd Ave. NE. _
�-a /Y..\ -R' R..v. w�-.'...M... WELL 10-1
O[RM
l ti OL
USE
MARaM O►
i. FTlRYATIOM LL=COLOR ►ORYA RJM ►'ROY TD 70T.. 1U.R
RLIN & MAXINE S ND
776 63rd Ave. NE. �V
Fridlev.
le—.I.e.MI R...• -
Sept. 16th, 8
.d K3 AR 80Rww 110
bog~ ROR..w "W
doF.YM - -, 10 ""a"
110-..111\. ROU--.ar
-LJ AY C..&R..1- Go
Gravel & Stones
gray
0
122
T CAS MG KEKWd_Wt--
yYw' 'a"'"`° l
low~ IL
11c" OL"
Shale
Black
122
126
low GC- °""s"' Tw— R.x-
l- , . w 19R ..1� 2.273....
—�•—a
S t . Peter
;ah i to
130
119-6
rSt . Peter
yellow
130
186
Y... Probably
Shakopee
tan
186
195
_
*r- Unknown KOTTTUOW
s..1G-w L.Rp►
Shakopee
buff
195
265
'"\"'_ a. Mw a.
a Md a.
L Jordan
yellow
265
0 STATIC
20 ^TFA LEvLL
� o.T.r Ywo..A 9-16-8
'.. raYrmLEVEL lb'I k-...1.-1 Not Pumped
RM. M►R—MU .aa.
W
U REY.AAa► C,di AT/OF fly OP DATA. �L
Geological data from: the city well of
Fridley. Well # 8 at 6431 University.
F— .s.. t 0 K _ -
\O Fa—-.s......e..w1w
1O Rw.w..1 dO- jOA/ Y— tf w.w p.`
II �RSi OROVTiD'!
y IOIT. OM.
►FS M.. C.rn
206—W Jo
C,.-- PortlancL21 . Surfacg
Neat
C,-„1, t
u MMOL MM= or pcs OOMTARm1ATM
_
55 1. NL—..Y- C i
W.R N.d.n...iP--a/1...! .-o mo
M- /VII►
mew DUN rri\
GONE
Y... Y.w\. IS yr
r -.1r s, sq R..
Trw 101.a. -.+\r SayyLt lYrYr ROR.aR1aw1,
10►. �ii....rr+ \O
16 WATER WELLCOMTRACTOR7CLRTIF1CATWF
TE, -a w OYd mew W, ^1. - -R d. wpm R aw, w
Rlo•. ORRT '
Chrisye d SEP 16
9_87
t�a
F WATER WELL ABANDONMENTS
FOR ANOKA COUNTY
LISTED BY CITY
NUMERICALLY BY ADDRESS
FOR THE CITY OF
*** FRIDLEY ***
6431 UNIVERSITY AVE. NE.
B.I. MR. DARREL CLARK & MR. DON 9ARRIGAN
574-3450
NO PERMIT FEE OR INSPECTION
DRILLER SIZE OWNER -CONTRACTOR SITE ADDRESS DATE SEALED
TORGERSON
1t
BORDEN
260 Longfellow.St.
Jan.
88
E.H. RENNER
2
SHARON ANDERSON
380 Longfellow St.
May.
86
MORS
3
ANOKA CO. COMM. ACTION
400 Osboraf-Rd.
Sep.
87
MORS
3
ANOKA CO. COMM. ACTION
401-76tb Ave. NE.
Sep.
87
A -WELL
4
ELLEN KARI
511 Ironton St. NE.
Mar.
88
E.H. RENNER
2
FRIDLEY SCH. DIST #14
611 Mississippi St.
Sep.
87
E.H. RENNER
1k
HARLIN & MAXINE SUND v776
-63rd Ave. NE.
Sep.
87
TORGERSON
3
Robert Knudson
1322 Hillcrest Dr.
Jul.
88
E.H. RENNER
1k
LOIS HLAVINKA
1500 Osborne Rd.
Apr.
88
E.H. RENNER
1k
LOIS HLAVINKA
1500 Osborne Rd.
Apr.
88
E.H. RENNER
2
OMAN CORP
1600 -71st Ave. NE.
Jul.
88
E.H. RENNER
2
ONAN CORP
1600 -71st Ave. NE.
Jul.
88
E.H. RENNER
3
JERRY McKNIGHT
4607 -2nd St. NE.
Nov.
87
E.H. RENNER
3
SYLVIA McGUIRE
5928 Oakwood Ave.
Sep.
87
E.H. RENNER
1k
SYLVIA McGUIRE
5928 Oakwood Ave.
Sep.
87
E.H. RENNER
3
BINCKNER BUILDERS
5980 Stinson Blvd.
Apr.
88
E.H. RENNER
3
TIM FAHS
6105 Woody Lane
Feb.
88
E.H. RENNER
4
TIM FAHS
6105 Woody Lane
Feb.
88
DON STODOLA
4
ENEBECK CONSTRUCTION
6222 Old benbwf Rd.
Aug.
88
MORS
2
CLARENCE GRAVES
6229 Sunrise Drive
Oct.
87
LUDWIG
2
CARL CHRISTENSEN
6509 East River Rd.
Jun.
88
E "• RENNER
1k
ANOKA COUNTY PARKS DEPT.
6666 East River Rd.
Jul.
88
E REHM
1t
RICK MALACHER
E., RENNER
1%
BOISE
CASCADE
CORP/BARB
E.H. RENNER
lk
BOISE
CASCADE
CORP/BARB
E.H. RENNER
1%
BOISE
CASCADE
CORP/BARR
E.H. RENNER
131
BOISE
CASCADE
CORP/BARB
E.H. RENNER
141
BOISE
CASCADE
CORP/BARR
E.H. RENNER.'
11
BOISE
CASCADE
CORP/BARR
E.H. REN HER.
1k
BOISE
CASCADE
CORP/BARR
E.H. RENNER
1%
BOISE
CASCADE
CORP/BARR
E.H. RENNER
1%
BOISE
CASCADE
CORP/BARB
E.H. RENNER
I%
BOISE
CASCADE
CORP/BARR
(10 WELLS..FP7, FP10, FP18, FP11,
FP13, FP9,
[ALL OF THE
ABOVE
10 WELLS FOR NATIONAL POLE
E.H. RENNER
1t
JAMES
L. SCHLEP
A -WELL
2
JIM HAM
ANOBA/018
END NOVEMBER 16th, 1988
NUMBER OF WELLS SEALED IN THIS CITY TO DATE:
2
7136 East River Rd. Aug. 87
7300 Block & Old Central Aug. 84
7300 Block & Old Central Aug. 84
7300 Block & Old Central Aug. 84
7300 Block & Old Central Aug. 84
7300 Block & Old Central Aug. 84
7300 Block & Old Central Aug. 84
7300 Block & Old Central Aug. 84
7300 Block & Old Central Aug: 84
7300 Block & Old Central Aug. 84
7300 Block & Old Central Aug. 84
FP1, FPB, FMB, FP3 Less Than 30')
& TREATING SITE/MEDTRONICS SITE]
7512 East River Road Sep. 87
7551 Alden Way NE. Jun. 88
35
SUBJECT
City of Fridley28078
AT THE TOP OF THE TWINS
BUILDING
D[ DCR M
�
r
O
�•
_ ___ COMMUNITY DEVELOPMENT DIV.
V
f � � PROTECTIVE INSPECTION SEC.
&6
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
s�aF�s
11012198612-571-3450
JOB ADDRESS
776 63rd Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
2
9
Christie
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Gerald Peterson
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Doug Paulson Const. P.O.Box 247 Anoka MN 55433 427-2643 6329
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 Rk REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (22 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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 80 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
1885
$.94
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUC NOR TME PERFOR ANCE OF CONSTRUCTION
$59.50
Fire SC $1.88
PLAN CHECK FEE
TOTAL FEE
a. I�/O/
License 5.00
$6/32
C&AATUOf OF CONTRA TQA OR AUTHORIZED AGENT iDATEo
N P OPERLY V LIDATE T IS IS YOUR PERMIT
S,GNATURE OF 0WNEA,1F OWNER BUILDERI iDATE)
NSP
- QAtE
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY Q
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 D f„
BUILDING PERMIT APPLICATION p O U04`
ConstructionAddress: 77�, & 3`2 !::j ('Ie— A/ f _
Legal Description:
Owner Name & Address: Ge-r-,Iee E sc, , . �71-� (,3 14-0bi -" . /J_ £_ Tel. #
Contractor: MN LICENSE # (032.
Address: 13bk ? Tel. # -�,O-7 - -?-(-Y3
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:
k'5 N-.S� a- -n:
0 TEWi-ver
Construction Type:
k2►•,
Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft.
+ 6 Ft = Ft x $ _ $
DATE: APPLICANT: > > y Tel. # 4/P - ;2 �3
C� CITY USE ONLY
Permit Fee $/.% Fee Schedule on Reverse Side
Fire Surcharge $��a .001 of Permit Valuation (1/10th%)
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $1000 per SAC Unit
License Surcharge $ S U U $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:
[ CITY OF FRIDLr:Y
NEW
ADDN [ ] 6431 University Ave NE, Fridlev, MN 55432 7P'� Effective 1 Bldg ��
ALTER [ ] SINGLE FAMILYAPtn DUPLEXES R=-1 AND f�_2 ( ] 72-1287 Pax hlsn
BUILDING PERMIT APPLICATION
(763) S7 (.i21t7 Fax
Construction Address: �'� �� j ;' �� �- �A --I,
Legal Description:
Owner Name &Address; POOFING & REhj0fjl�l_1N�;,
�iQ�- xe�tStt�r�B�vU. tNG
Tel- il,
Contractor: [��: 6 UI MN LICENSE � � J
Address: ID #0001050
Tel. # G/L -
Attach to this application, a Certificate of Sunfey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTIOP! OF MAPROVCMENT
LIVING AREA; Length Width Height__
Sq. Ft.
GARAGE AREA: Length Width Her' ht
9 . Sq. Ft,
DECK AREA: Length �^ Width-,. Hgt/GroundSq. Ft. �
OTHER: --
w
Construction Type:
Estimated Cost: A_
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =
DATE:A&41- APPLICANT:
Call (763) 572-3604 for Perm't F
lel.l� �G 07�I.J
you for card number.
ees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
,
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
Fee Schedule on Reverse Side
$ 3 .001 of Permif Valuation (1/10th%)
$ 1 $.50/$1,000 Valuation
$ $1350 per SAC Unit
$ 6-06 $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450,00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ j Not Ner_.essjry r
cTiF(_II_nTf�Fl�.
t7 UPJ VfiV UVVVJa 0 JIVI7VVU V 1 1) �VVI1 1U �OUI� AUL 1JV
-9- 1 (Oqs
�IgSo�s
Building
BUILDING
(USING THE 1997 U.B.0 FEE SCHEDULE)
Permit No.: 7 , I
Inspections
OCCUPANCY TYPE
RESIDENTIAL APPLICATION
$
Received By:
763-572-3604
$
CITY OF FRIDLEY
Fire Surcharge
Date W@ SEP 120
763-502-4977 FAX
Surcharge
$
.0005 x Permit Valuation Minimum $5.00
License Surcharge
$
EFFECTIVE 7-1-2010
SAC Charge
$
DATE — 0
E-MAIL ADDRESS
$
SITE ADDRESS
,yYOUR
$
THIS APPLICANT IS:
❑ OWNER IRCONTRACTOR
$
PROPERTY OWNER/
NAME: GaA.4 k
$
TENANT
ADDRESS:,�(p (. 3r,/ A.M t CrrY rI I
'n gut
STATE , ftIP
Y Make checks savable to: Citv of Fridlev Attach Stipulations
PHONE: --) (0 - ' `` I l r q4�' S S
CONTRACTOR
NAME:
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # EXP DATE
AND CERTIFICATE OF
ADDRESS: 301% SC,t S��. /be) CITYEtud
tAe_STATEJYUVZIPS-9C71:0�
INSURANCE
PHONE I - 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 IN SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: — S ZSi
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
JR HOUSE & GARAGE
1.
Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
13 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 ❑Yes ❑No LOCATION OF WINDOWS
FOR WINDOWS
— PROVIDE U -VALUE AND
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $
OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
ih .001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $5.00
License Surcharge
$
�? $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $24 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( }
Total Due
$
Y Make checks savable to: Citv of Fridlev Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of 94 work Which uires re a and approval of pl _ / t
SIGNATURE OF APPLICANT / cy�(jG.q PRINT NAME/YUP �/ a �r iL DATE `�
APPROVAL INSPECTOR SIGNATURE
PLEASE NOTE: SEPARATE PERMITS ARE REOUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK
10