PRE 2010 DOCSBUILDING PERMIT
Village of Fridley, Minn. No 2 Q 2 0
Date / 2....... ....................
!�!'- Builder ...........................................
Owner .......
Address'Jf•�... dress .........................................
LOCATION OF BUILDING
No. .9?0 .-P......... Street .46,7, „ ...�... .. ..... Part of Lot .......................
Lot ........ . ;�.... Block ..... 4.w....... Addition or Sub -Division Aa ..�..av�y
Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ...........................
DESCRIPTION OF BUILDING
To be Used as:
... Front Ll 4... Depth .�W... Height l i� ..... Sq. Ft. /".4 Cu. Ft. ........
.................... Front ........ Depth ........ Height ......... Sq. Ft......... Cu. Ft. ........
9®® Ad
Type of Construction/�2r?:Y4C... Est Cost . /,. 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 village of Fridley.
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 ted 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 with-
in the village 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 Items.
City of Fridley, Minn.
BUILDING PERMIT N°311
Date:
Owner: Builder
Address _ _ Address
ONON
r' G
ILDI
No. � Street �� �' ,��4%Y
Part Of Lot
Lot
Corner Lot
Sewer Elevation
Block Addition or Sub-Divisin
.� Inside Lot f3etback�.:._.._._..._..._ Sideyard
Foundation Elevation
DESCRIPTION OF BUILDING
To
Front Depth Height Sq. Ft. ,-•^ Cu. Ft 7
!Mfa
Depth t Sq. Ft. Cu. Ft.
Type of Construction ' IT
,,, Est C __ 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 fora: and in compliance with all provisions of
ordinances of the city of Fridley.
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 regarding location, construction, alteration, maintenance, repair and moving of buildings
or� the city limits and this permit may be revoked at any olation any of the provisions of said
Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we
the Building Inspector for separate permits for these hems.
4 0 4 ` ,-4
O•.-ner I a
Address
No.
APPLICATION FOR RUIID=, FSM
r%Tri V M VOTMTV..'#. u11QAT6't kArPA
of Lot
Lot Block Addition or Subdivision
Corner Lot Inside Lot Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
Sq. Ft. '�� Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Coat
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 and representations
stated in this application are true and correct.
DATE ���1z� SIGNATURE
(A Schedule of Fee Costs can be found on the Reverse Side.)
Applicaffor-Power Pkmft and Heati ft Cooling. Yenoa&n. Resp a and
Air Conditioning Stens and Devices
PARTIAL RATE SCHEDULE
GRAVrTY WARM AIR: MTN 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 AIA
Furnace Shell & Duct Work to 120,000 BTU... ..$10.00 $_
each add. 60,000 BTU .. ................. .. 3.00 i
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
FurnaceShell & 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
GAS BURNER (up to 189,000 BTU)
over 199,000 BTU gee Fee Schedule
GAS FITTING FEES:
1st 3 Fixtures
Additional Fixtures
Gas Range to 199,000
AIR COIfDTRONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FL11AL �
&00 $
NO RATE TOTAL
- x$ Z00 $
- x .75 $
_ a$ 8.00 $ _
0,4C�
See Fee Schedule
TOTAL FEE $
Dept. of Bldg.. Phone SM -3480
auk
City of Fridley:
The undersigned hereby makes application for a permit for the work hereir
specified, agreeing to do all work in strict accordance with the City Ordinaneee
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_ aAO4_1 lg
Owner
Kind o1 Building
UsedTO be completed about
e,�^Pe�U
l
Estimated Cost, $_-_-s1..f.1
Old—New. Building Permit No. Permit No.o� /off
DFaCAiPTION OF WORK
HEATTN or POWER PLANTgSteam, Hot Water, Warm Air—No
Trade Name. �Size Ne_.� �® �m✓��
Capacity Sq, Ft, E.D,R c,? ?x9 EJ 13TUJ H.P
Total Connected Load Kind of Fuet
BURNER — Trade Name Size No
Capacity Sq. FL E.D.R BTU
B1p.
(SURCHARGE " .50)
/ O (RE ARKS -OVER)
E
SUBJECT
IT NO. ,,
City of Fridley
16114
AT THE TOP OF THE TWINS
BUILDING PERMIT
'
R
'
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
J
"1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
14/10/81
JOB ADDRESS 400 - 67th. Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6
5
R21M Rice Creek. Terrace Plat Jr ,3 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Mike Nieman 400 - 67th Avenue N.E. 571-0573
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 ❑�
[I11NEW ADDITION % ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install patio door and patio
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REQUIRED FOR WIRM40c
HEATING, PLUMBING AND SIGNS.
G
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
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
$7QQ
$.5O
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-
$7.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$8.00
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDAATEI
WHEN PROPERLY ALI DATED THIS IS YOUR PERMIT
10-"r / -
- ' /\QJ
BLDG INSP DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
E
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDI1iG PERMITS
(New, Alterations, Additions, or Repairs)
• OWNER: M l hc- 6�leth .4 J BUILDER:
ADDRESS: V0 a Axa, '4VIIve ADDRESS:
TEL NO: 0-0-7 TEL NO:
'
Construction Location '
STREET NO: fQ c7 STREET: 4
J
LOT: (p BLOCK: ADDITION:
Corner Lot: Inside Lot: Setback:
Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
-4�-�i(o
�ooP--
Front: Depth:
Height:
Squame.Feet: Cubic Feet:
Front: Depth:
Height:
Square feet: Cubic feet:
Type of Construction: Estimated
Cost: $ %®
To Be Completed: _ _L�/� r / - /- a
`
Alt. A Alt. B
Proposed Driveway Width If New Opening Is -Desired:
$ $
SEE
REVERSE SIDE OF SHEET
The undersigned hereby makes application for a permit for the tvrk' 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.
MTE: Y /O ' SIGNATURE: .
Stipulations:
S0 • • -
6
Building
BUILDING
Permit No.: 200trs fo
Inspections
RESIDENTIAL APPLICATION
Received By.AJ94/
763-572-3604
CITY OF FRIDLEY
Dat ' - 6 ` - 8
763-502-4977 FAX
EFFECTIVE 1-1-08
DATE
4
YOUR E- L ADDRESS
SITE ADDRE S
^�
`7C �= #
THIS APPLICANT IS: OWNER ❑CONTRACTOR
PROPERTY OWNER/
NAME: D e. ,
ADDRESS:(Q-7&A &?=e iiJ% CITY XA_ I d L�a Li STATEft_ZIP 2,
TENANT
PHONE: —2`6 3 —
NAME:
ADDRESS: CITY STATE ZIP
CONTRACTOR
SUBMIT A COPY OF
PHONE FAX
YOUR STATE LICENSE
STATE LICENSE # EXP DATE
PROPERTY TYPE
❑ SINGLE FAMILYNEW CONSTRUCTION SIZE
❑ TWO FAMILYNEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED P WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK C SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR IN REMODELING
DESCRIBE WORK BEING DONE: A
SIZE OF IMPROVEMENT
ENGTH 6r WIDTH HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
❑ HOUSE & GARAGE
I. Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used.
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
Vinyl
(Soffit
ADDITIONS. & PORCHES SUBMIT:
I. Site Plan/Survey showing the existing structures
13 Aluminum
❑Trim
and proposed project.
11 Other
Fascia
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS RYes ❑No LOCATJ9N OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMI OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ / bow • ®o OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ = 3.9 5' See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ 15.00 .001 times the total job valuation
$ (D .57) .0005 x Permit Valuation Minimum $.50
$ $5.00 (State Licensed Residential Contractors)
$ $1825 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ r!, 4/o • 75 Make checks Payable 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 on site; that the woelcwtLl be in acro ance with the pproved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPJ C�LNT PRINT NAME �d L ea/�2 l d rt�1 ail DATE LP 3
APPROVED BY t ,-%� s , i/, ., A ._ DATE
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
BUILDING PERMIT APPLICANT: PROPERTY OWNER
—7 ,
I, G understand that the State of Minnesota
re uires that all residential building contractors, remodelers and roofers obtain a state
license unless they qualify for a specific exemption from the licensing requirements. As
the owner of the property at r 7'�i D O)%E, , Fridley, I
am exempt from the state licensing requirement only if I am not building or improving
this property for purposes of resale. By signing this document, I attest to the fact that I
am improving this house for my own use and do not intend to sell it. I hereby claim to
be exempt from the state licensing requirements because I am not in the business of
building or remodeling on speculation or for resale and that the house for which I am
applying for this permit, isl the first residential structure I have built or improved in the
past 24 months. I also acknowledge that because I do not have a state license, I forfeit
any mechanic's lien rights to which I may otherwise have been entitled under Minn.
Stat. 514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to perform
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is
a misdemeanor under Minnesota law, and that I would forfeit my rights to
reimbursement from the Contractor's Recovery Fund in the event that any contractors I
hire are unlicensed.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to the City of Fridley for compliance with all
applicable building codes and city ordinances in connection with the work being
performed on this property.
Name
Date