Pre Demo DocsCity of Fridley, Minn..
BUILDING PERMIT No" j
5441
Date:
Owner: ' a Builder )"2004.4ff-4
A Address — —
LOCAT, OFUULNG
No. Street - -- rPart o1jrot _
Lot d _ Block _____ AdditlZor Sub-DivWonn--!�.-
Corner Lot Inside Lot Setback __: Sideyard
Sewer Elevation _ _ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front — Depth Height — Sq. Ft. — Cu. Ft.
Front __ _ Depth Height Sq. Ft... Cu. Ft. _
Type of Construction Est. ; .__""�
- --to be Completed
.�.�....
In consideMion 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.
r -Ir ,.
In considerationn of the payment of a fee of $_OV"'"'A 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
pvithin the city limits and this permit, may be revoked at any time upon violation of any of the provisions of said
ordinances. ..... A
Building Inspector
NOTICE:
This permit!, does not cover the construction, installation for wiring, plumbing, Baa heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items,
SUBJECT
PERMIT NO.
City of Fridley
NO 14591
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
r � PROTECTIVE INSPECTION SEC.
�
1 = �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
3/8/78
10B ADDRESS 95 Mississippi Way N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
20
6
Fridley Park
SHEET
2 PROPERTYOWNER MAIL ADDRESS
ZIP PHONE
Dennis Dittmer 7585 Alden Way N.E.
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Richard Hastings Co. 6331 Riverview Terrace
560-2610
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 ❑ REMOVE
8 DESCRIBE WORK
Em Reroof dwelling (Partial tear -off)
9 CHANGEOFUSEFROM TO
STIPULATIONS
install ridged galvanized valleys. New roof can be 2nd but not
3rd roof.
SEWRATE PERMITS REQUIRED FOR WiRi
HEATING, PLUMBING AND SIGNS.
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
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
$1.,300
$.65
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.
$9.00
PLAN CHECK FEE
TOTALFEE
5
$9.65
r
SIGNATURE OF CONTRACTOR OR AUTHOFffjfED AGENT (DATE)
WHENMRLY VALIDATED THIS IS YOUR PERMIT
1.
BLDG )NSP
IA
n TE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DAT EI
CITY 01= FRIDLEY
APPLICATION FOR RESIDEENTIAL BUILDING PERMITS
ANEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER: 1),NN" 5
TrMd C 1
BUILDER:
'� `ch A
P n OA
S C o,
Address: 75 YS Ak
of 1� r/ L,-) A�
Address :(.'3
3 I
yrS Zy; i`ig! R
Tel. No.:
56®
-2i -lo
No.: y5
Street: Mi6S
. L�)^4
Al. f
LOT: ®
BLOCK: �_
ADDITION:
Ff i` d Lt j/
?A?--
A el cI • �a ° o��
7`
CORNER LOT:
I14SIDE LOT:
SETBACK:
SIDEYARDS:
Applicant attach to this form T<vo Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Front:
Depth:
Square Feet: Cubic Feet:
Height:
Front: Depth: Height:
Square Feet: Cubic Feet:
?Aitf-"%L te1-06F -+-
Type of Construction: V�qrr-1-aAC tQAROFF Estimated Cost: $ 1,3049. n®
7b Be Completed: ly'/`S/7 9' 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 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. See reverse side for additional information.
DATE: 3 Y % _ SIGNATURE
Stipulations:
BUILDING PERMIT FEE 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 in the manner herein provided to -wit:
NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet.
PLAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSION: (Concrete Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x $14.50
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3 foot wide approach with
6 inch depth; Driveway width plus 6 feet x $17.20
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 line 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 $7.50 plus $.50 state surcharge.
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 Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
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.
w s
COIFY 07-
8431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 5.5432
TELEPHONE 1612)571-3460
_PBSTRUCTION:
Lot Block Addition
/11. <-ve-e-QPiac
hmperty Owier-.address
RE -CORD OF COMMUNICATIONS:
I -
1.
2.
3.
4.
3.
G.
7.
SUBJECT
PERMIT
of Fridley
O - -16 8 2 2
AT THE TOP OF THE TWINS
BUILDING PERMIT
rpCity
R
II L
COMMUNITY DEVELOPMENT DIV.
r 1 ~ PROTECTIVE INSPECTION SEC.
1 ,
,
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
i1 =
,----1;,1 CITY HALL FRIDLEY 55432
J�"
L 612-571-3450
910-F15
10/13/82
JOB ADDRESS 95 Mississippi Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
20
6
Fridley Park Addition SHEET
2 PROPERTYOWNE MAIL ADDRESS ZIP PHONE
Dennis �.ttmer 19 7595 Alden Way N.E. 571-7585
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
D & D Home Improvement Inc. 1670 Camelot Lane N.E. 574-1398
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 E3A ALTERATION ❑ REPAIR ❑ MOVE 0 REMOVE
8 DESCRIBE WORK
Install aluminum trim
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.
Aluminum
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
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
$.73
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,450
DOE NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
pERM1T FEE
SAC CHARGE
PRO ISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRU TION A THE PERFORMANCE OF CONSTRUCTION.
$25.00
PLAN CHECK FEE
TOTAL FEE
VFf
-
$25.73
SIGNAT REOFCONTRACTOR(:RAUTHORIZEDAG NT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
19 j �-a-
BLDG INSP t OA E
SIGNATURE OF OWNER 0F OWNER BUILDER) (DATE)
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATION FOfi RESIDENTIAL BUILDING PEF04ITS
(New. Alterations, Additions, or Repairs)
DMJNER:
ADDRESS:
TEL NO: J71z 75 :LE
BUILDER:
ADDRESS:
TEL
TEL NO:
Construction Location
• STRI-TrT NO: STREET: �� `-SS% S /� /Y7
LOT: BLOCK: ADDITION:
Corner Lot: Inside Lots Setback: Sideyards:
Applicant attach to this fora two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
Front: Depth: Height:
Square Feet: Cubic Feet:
• Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: &a-2!'/- //Cid Estimated Costs S J�� ev
To Be C,rapleted:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ S
SEE REVERSE SIDE OF SHEET
Mie undersigned hereby makes application for a permit for the v=k 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: ,,_ 6112(-- SIcxnTvr�:
Stipulation:
�5,�3
BUILDING PERMIT FEE SCHEDULE
The Inspector of buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any
•xisting 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 Ln the manner herein provided to -wit:
TOTAL VALUATION FEES
$1.00 to $500.00 $10.00 !Minimum Fee $15.00 plus surcharge
$501 to $2,000 $10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and
including $2,000
$2,001 to $25,000 $32.SO for the first $2,000 plus $6.00 for each
additional $1,000 or fraction thereof, to and
including $25,000
$25,001 to $50,000 $170.50 for the first $25,000 plus $4.50 for
each additional $1,000 or fraction thereof, to
and including $50,000
$50,001 to $100,000 $263.00 for the first $50,000 plus $3.00 for
each additional $1,000 or fraction thereof, to
and including $100,000
$100,001 and up $443.00 for the first $100,000 plus $2.50 for
each additional $1,000 or fraction thereof
PLAN CHECK: 25 percent of building pezmit fee
DRIVEWAY DEPRESSION ESCROW: Concrete Curb Streets Only
Alternate "A": Removeal and replacement of curb and gutter only
Driveway width plus 6 feet x $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 x $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 been constructed will be required before proceeding with the framing.
I
SUBJECT
,
City of Fridley
32476
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RE„ IPT NO.
` ___��_ COMMUNITY DEVELOPMENT DIV.
_
�
INSPECTION SEC.
r'
f PROTECTIVE
F 3
7
i i �
a I CITY HALL FRIDLEY 55432
It "''
It
NUMBER
REv
DATEPAGE
Oi ,a�
APPROVED BY
612-571-3450
910415
3/25/02
/
JOB ADDRESS 95 Mississippi Street NE f/
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
1
6
1 Fridley Park Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Connie Swenson 95 Mississippi Street NE 763-571-7995
3 CONTRACTOR MAIL ADDRESS IIP PHONE LICENSE NO
RMA Home Services Inc 3200 Cobb Galleria Pkwy STE2"00, Atlanta, GA 30339
4 ARCHITECT OR DESIGNER . MAIL ADDRESS'' ZIP PHONE LICENSE NO.
763-542-8826 20268257
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential F^"
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION REPAIR O MOVE ❑ REMOVE
a'
8 DESCRIBE WORK �r
Reside front of hoile with Encore viriyl siding - not removing existing siding
9 CHANGE OF USE FROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive
barrier be paced over�ex{'rtor sheathing to protect the interior wall covering.
Exceptions for this prov�'sion would be'if sheathing is an approved weatherproof
panel or when the sidin Iis an approved weather barrier. Vinyl siding is not a
weatherproof covering rless`the man ufacturer'states this in their application
guidelines. Call for -'inspection of wrap before covering. Caulk and flash all
exterior openings.
fie”" InSPOCUon Cards
III PAalled
To Homeowner To Post
SEPARATE PERMITS ARE R UIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CO ITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT.
AUTHORIZED IS NOT COMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPEND D OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WO K IS COMMENCED.
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY HAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
AND KNOW TME S ME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANC S GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$29496
$1.25
WITH WHETH SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT RESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$83.25
Fire SC $2.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
ns'# SC $5.00
$92.00
SIGNATURE Of CONCRACTOR OR AUTHORIZED AGENT IDATEI
N PROPERLY VALIDATED THIS IS YOWR PERMIT
S,GNATURE OF OWNER .Ic OWNER BUILDERI 10ATEI
%B OG INS, IArt
I
NEW [Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: � q':-� rn',��► �G.[�n ; 41.f ;,.� L
Legal Description:
Owner Name & Address: ���t1`(1;�-2 �� SON Tel. # 3-(c3. J •-�j`j�'
Contractor:; RMA HOME SERVICES INC. MN LICENSE #
Home Depot Installed Sales
Address: 3200 Cobb Galleria Pkwy., Ste. #200
Atlanta, GA 30339 Tel. #
,4.763-542-8826 urvey. of the
1c BC-2026825i__i in -4t to scale.
DES.C—RnKT14bN OF Wpm(')VEMENT '
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: lui-vcU .a,ncc� a )kS L,iA-k '71CJY-e. \1. n i .1 C -,--.A' r
Nb S -.dl fqA) ------- T- U
T
Construction T
YPe� Estimated cost: _ a,y qCq
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE: @-.f U!A-OA APPLICANT: y Tel. # 15a.3�i�•W44
Permit Fee
$ , a5
Fire Surcharge
$�
State Surcharge
$ , . o1CJ
SAC Charge
$
License Surcharge
$
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 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 [ ]
TOTAL
STIPULATIONS:
SUBJECT
.
City of Fridley
A33L7 0
AT THE TOP OF THE TWINS
BUILDING PERMIT
P3k
E,
16W COMMUNITY DEVELOPMENT DIV.
RE
E PT NO.
-7-3
r E PROTECTIVE INSPECTION SEC.
� CITY HALL FRIDLEY 55432
NUMBEii
REV
DATE
PAGE OF
APPnOVED By
1 763-571-3450
910-F 15
3 / 17/03
JOB ADDRESS 95 Mississippi Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
20
6
Fridley Park Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Connie Swenson 95 Mississippi Street
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Maintenance Free MN 4216 83 Ave N Brooklyn Park MN 55443 763-560-6141
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
20266987
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION] REPAIR O MOVE O REMOVE
X
8 DESCRIBE WORK
Reroof House & Garage (tear-off)• Reside House & Garage
9 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. Caulk and flash all
exterior openings. Underlayment must comply with the State Building Code.
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 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
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
$1(1,685
$7.34
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-
$251.25
Fir SC $14.68
TRUCTION OR THE PERFORMA E OF CONSTRUCTION
PLAN CHECK FEEq
TO AL FEE
Licen $5 0
278.27
,OFKNA TUITE OF CON' RAC TOR OR AUTHORIZED AGENT (DATE.
E PRD VAL A D THIS IS R RMIT
S-GNATURE OF OWNER,iF OWNER BUILDERI iDATE.
B OG01 p E
NEW [ ] _ . - CITY OF FRIDLEY Effective 1/1/2003
ADDN [ J 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R4 AND R-2 (763) 5714287 Fax
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name & Address Tel. #
Contractor. MN LICENSE # 174
Address: ���� '` `� s?✓�c�v�G �✓ ��r� ll Tel. # 7 & - y - �i® Zo
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
OTHER:
Width Hgt/Ground Sq. Ft.
a,
Construction Type:/Z�- Estimated Cost: $
i
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$
01
DATE: 5-17-0APPLICANT: A -r = ✓�. /-�e dZ�' -✓ Tel. # Z6 3
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
dJ' Fee Schedule on Reverse Side
$ L .001 of Permit Valuation (1 /10th%)
$ °) . `3 $.50/$1,000 Valuation
$ $1275 per SAC Unit
$ C Cu $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 [ ]
$ —4 /6.C)-% STIPULATIONS'
BUR DING 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
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
$1,000,001 and up $5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
CURB CUT ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet times $17.00.
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.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Only
r
From: 6506556633
From: Mike Nelsen Fax: +1 (966) 612-3616 To: Mary
r
CM OF FML"
6431 University Ave NE
Fridley MN 55432
(763)572-3604 FAX (763)571-1267
Job Address i��
Legal Description:
Owner & Address:
Contractor:
Address: (4 44 W til
I — 1
Page: 3/3 Date: 10/15/201010:57:13 AM
Fax: +1 (763) 602-4977 (Page 2 cof :3 '10!162010 10:66
MovmG (10Emo KP
eA ON
HOUSE: Length
Width
Height
Sq. Ft. Cu. Ft-
GARAGE:Length
Width
Height
Sq. Ft. Cu. Ft.
OTHER: Length
Width
Height
Sq. Ft. Cu. Ft.
Estimated Cost
$ Le Ono ,,or_
Approx.
Completion mate J
CALL GOPHER OVA!! ONE AT 651-454-0002 FOR UTILITY X=MONS. CALL ALL
UTILITSES FOR DI$000MCTS BS»'ORE ING STRUCTURE.
Moving Route:
APPROVAL (S) RBQUZBW PRIOR TO IS CL
MPGA: NOTIFICATION OF nMW TO PERFORM A DEMLITION ( ) YES ( ) NO
0 hater Bali Paid: Yen[ ] or Collect [$ ] S.ignatu"
M
LEI
Co dit:ions
Conditions 1-44-tocto cr i IS��r'c�i�GA�J�
Conditions
7t,%- wdmpW hmvby mattes aWmadm for a parmit to wmek/mave the bMft 4=iW above, agremg to do all work in strict
aCvM*= whh tt Cky Ores anti lulus of the Bandml .Division, and the State Cade which mp&m any water welt tm the
propmy w be sealed by a State homed water well drifter, ad hereby declares that aII 1= and rqn==d= and in this appli mtkav
are trw and comcL
ALL PRMLL 11(3N DEBRY.S. llNC7.IJDING FOUNDATION & SLAB. S 4U = gF. OVED MM SSPE.
j,�,
f 1 4ft -
Priwioe funding iva Frkley .... $300.00 For each 1,000 catbk feet or 1'ralxim.....$1.25
Accessmy buikrmg into Findley ... $ 42.00 For suumm which wmW be bWw ied to
Through or within the City ...... $ 20.00 tube, the fe= " be based on dw WW tot
Move a building cwt of City ...... $ 20.00 of wrecUng at the rate of $6.00 for each $500.00
or &action.
PERMT FM M1AiIlViUM $241.00 Office Use O}'% SAC -D form completed
Effeedve 1101,21110
From: 6506556633
Page: 3/3
Date: 10/15/201010:57:13 AM
From: Mike Nelsen Fax: +1 (866) 812-3616 To: Mary
Fax: +1 (763) 6024877 (Paye :3 tof 2ti 10!1612010 10:66
Cry OF FMLEY
MOVING
DEMO t, PE RMrr CAPON
643.1 University Ave NE
Fridley MN 55432
(763) 572-3604 FAX (763) 571-1287
A�
/`►
1
Job Address. }
�••-
'
Legal Description:
Owner & Address:,
Contractor: `.S
.�C-
Tel.
Address:
to License # ivy
D1aSCRlPnOi�TOF
rrs 530-7
HOUSE: Length Width
Height
Sq. Ft.)(�p(D Cu. Ft.
GARAGE.Length Width
Height
Sq. Ft. Cu. Ft.
OTHER: Length Width
Height
Sq. Ft. Cu. Ft.
Estimated Cost -ILtiQ ,--—
Approx. Completion Date
CALL GOPHER STATE OM AT 551-454-0402 FOR UMLYTY TAMTIONS. CALL ALL
UTILITIES FOR DISC CTS B&F= WtzCKrW&DV=G STIWCTURZ.
Moving Route:
APPROVAL(S) REQUIrM PRIOR//TO ISSUANCE:
MBCA.: NOTIFICATION OF INTER TO PERFORM A DE1 OLITION YES ( ) NO
U
0
A]
ullect r$ j Sis"ture r,
onditl6ns
0
Fire Marshal Conditions
The undemoad hereby makes qplirshm for a perm to wrecWD=e the bWbfmg described above, agred* to do all work n staci
aWXftm trill ft Cky ORbMM and M&P of dle 1 WWS Division, and the Stue Code wbkh reom any wor well rm the
property to be mated by a State licensed water well drgkr, and hereby declares that aII 1M and repremismiam mod in this apples
are true and correm
ALL RRMLL PPON PEM INCLUDING FOiJM!?LMN & SLAB MIL =COVED FROM R.
jz "% \
awe S'
M
Principle kdft iDtD Fridley .... $300.00 For ew.1,000 aft feet or ftw&m.....$1.25
wry huild4ng into Fridley ... $ 42.00 For suumm which would be kpmcdcal to
Through or within the City ...... $ 2().00 cube, the fee "be based on the Wta1 cog
Move a building out of City ...... $ 20.00 of wrt at Ii>e rate of $6.00 for each $500.00
or fmcdm
Effective 1101/2010
M1IUViLFM $20.00 Ofte, Use OW. SAC -D bm cmc
REcTOCT 2szoo
Engineering
WATER AND SEWER
Permit No.:do. iq
763-572-3552
PERMIT APPLICATION
Received 4.=
763-571-1287 fax
CITY OF FRIDLEY
Date Ra
EFFECTIVE 7/1/2010
APPLICATION DATE: YOUR E-MAIL/FAX:
THIS APPLICANT IS: ❑ OWNER CONTRACT R I
C
M f
JOB ADDRESS: J i fSJ/
NEW CONSTRUCTION PERMIT# (IF APPLICABLE).
PROPERTY
NAME: ,/✓ a 4
OWNER/
ADDRESS: CITY
STATE 6'i�LIP
TENANT
PHONE:
CONTRACTOR
NAME: S SZqol-r-1—
SUBMITA COPY OF
YOUR STATE
ADDRESS: 22va CITY l
STA ZIP��
LICENSE WITH
PHONE AVCELL PHONE:
APPLICATION
STATE LIC # STATE BOND: EXP DATE:
1. Narrative/written description: Q M (5;P
2. Please attach sketch showing curb line, utility line, building, etc. with distances on back page.
3. Stipulations:
PERMIT TYPE
J
❑ SEWER CONNECTION PERMIT $50
�6
❑ WATER CONNECTION PERMIT $50
X
❑ WATER LINE REPAIR $40
❑ SEWER LINE REPAIR $40
❑ ADD STATE SURCHARGE $5.00
70
❑ SAC CHARGE @ $2100 =
%)
TOTAL $
OTHER CHARGES (IF APPLICABLE) PAY TO UTILITY BILLING
NEW WATER METER COST – SEE UTILITY BILLING
SPECIAL ASSESSMENTS – SEE FINANCE
WATER TAP – SEE ENGINEERING
NOTE: WATER METER REPAIR, INSP OR SHUT-OFF / EVENINGS, WEEKENDS & HOLIDAYS
$125/HOUR-BILLED
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a water or sewer (new connection or repair) permit and I acknowledge that the information above is complete and
accurate; that the work will be in confion Pance with the ordinances and codes of the City of Fridley. I
understand this is not a permit but
only an application for a permit d w i iot to start without a permit.
�rvjp-s�
/��
��r/ 16
SIGNATURE OF APPLICANT AME:
DATE:
Id2 6 / O
APPROVED BY:
DATE:
COPY GIVE1 TO: ❑ UTILITY BILLING (only if new meter) ❑ PUBLIC WORKS
❑ ENGINEERING
City of Fridley
Engineering Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3552
FAX: 763-571-1287