AF - 35646BUILDING PERNiIT
Village of Fridley, Minn. N� 2 3 5 f
Date Q�`������ . . . . . . . . . . . . . . . .. . . . . . . . . .
�
� Owner ..�„L•�•�i.... .... Builder . . ..........................
Address .� f ,� �/. . . . .i�ylt.j:��,�,.� 1�RaP. �'� Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LOCATION OF BUILDWG
s� �}
No. ..�.�:. . . . Street . ��G%�%� :+�...!�/'�. . .. . . . . . . . Part of Lot . . . . . .. . . . . . .. . . . . . . .. .
Loi �� :r.�? . . Block . . . �j . . . . . . . . . . Addition or Sub-Division ',j��,�. a�t , , �, , , , , , , , , , ,
7
Corner Lot . . . . . . . . . . . . Inside Lot . . . . : . . . . . . . Setback .�/'. : :!�. Sideyard �D � .,,�/� . .. . . . . . . . . . . .
DES�CRIPT(ON OF BUILDWG
To be Used as:
.
������I�. . . . . . Front .� p. . . Depth .�fr, �. . . Height � . ,�,,. . . . Sq. Ft. � �Q . Cu. Ft. . . . . . . . .
.
y,��� V . . . . . . . Front .�. �. . . . Depth . .�, � . . Height . . ., Y. . . . . Sq. Ft. l� �G.`7�' Cu. Ft. . . . . . . . .
Type of Construction .............. Est. Cost���.�"...�.�'........... To be Completed .6.�j............
�t`
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.
�
r
,,
! ...................................................
In co ideration of the payment of a fee of $.�► .�,,,,., permit is hereby granted to ..� �.�y,,,y,�p.....
��rw�,.��;�j,�ay,�, . to construct the building�r ad dition as described above. This permit i5 granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in ai1 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 moviag 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. _ ,, ,.•�.�
.�:�,/. G!.,,J'�,�.'�(„r%t : f/�,t/,r[,;�y� Building Inspector
` NOTICE: `,
Z This permit does not�over 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.
� �
`,,a
"�
SUBJECT P
City of Fridley 13641
AT THE TOP OF THE TWINS B U I L D I N G P E R M I T •
r
; � EIPT N0.
� �y _ _ COMMUiJITY DEVELOPMENT DIV. ��� � �
r � � PROTECTIVE INSPECTION SEC.
1 � �
�� � /"'1 � CITY HAIL . FRIDLE� �55432 NUMeEa REV. DATE PAGE OF APPROVED BY
----� ' '•' s, 2-�so-s4so s1 o-F� 5 7/ 13/ 76 / /
�oe AooRess 6350 Ab1e Street N.E.
LOT NO. BLOCK TRACT OR ADDITION
1 LEGAL SEE ATTACHED
oescR. 5,6 6 Florence Park SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
James McClu�ky 6350 Ab1e Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Custom Pools, Inc. 701 Excelsior Avenue E. Hopkins, Mn 55343
4 ARCHITECT OR DESIGNER MAfL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS 21P PHONE LICENSE NO.
fi USE OF BUILDING
residential
7 CLASS OF WORK
❑ NEW C� ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
install a 20 x 38 swirr�tin o01
9 CHANGE OF USE FROM TO
STIPULATIONS
. Must r�et all the requirements of a ietter sent to the pool company
and the property owner, dated July 14, 1976
SEPEfiATE P�t7M17'S REQUtRED FpR -WYI�r -.
N�RTI�VG, Pl�UM81NG AND SI�NS, � ���
SEPARATE PERMITS ARE REOUIRED FOFi ELECTRICAt, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. St@�� 8! V111 �
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OA 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 APPUCATION 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 $5 �p�O 2. 7O
WfTH WHETHER SPEGFIED HEREIN OR NOT. THE GRANTING OF A PERMIT Q
DOE6 NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON- p
STRUCT N OR THE PERFORMANCE OF CONSTRUCTION. 3'i. HO
PLAN CHECK FEE TOTAL FEE
\ �/-3 %� $3T.7Q
S ATUf;E FCONTRACTORORA R EDAGENT � IDATEI � PROP �ALIDATE �THIS IS YOU PERMIT
L�-�i�-� .�-r � (,
SIGNATURE OF OWNEA IIF OWNER BUILDERI � IDATEI ' BLDG INSP OATE
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL ALTERATION,
ADDITION, OR REPAIR B�ILDING PERNfIT
OWNER' S NAME �� � S y 6 � c� L u. S l'� �Q BUILAER : Cc��S� a JV1 t"o� � S .=N C-
ADDRESS :(4,��� �� SZL• ADDRESS : 7D /\ 1�X �£ L 5! 0�- A� i. �
�yo�K� v� s r�� s S3U 3
N0 :.�.3 S� S TREET : IT Q L�
• LOT: BLOCK: ADDITION:
CORNER LOT: INSTDE LOT:_ � SETBACK: SIDEYARD:
� ,
Applicant attach to this form Ttao Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
�
_ ,
DESCRIPTION OF BUILDING
To Be Used As: •
,/ � �,`, ('
Sw,nnM��� I�o �L Front: �OXv��j Depth: � �; ���'o�
a
Square Feet:,� (0 8 Cubic Feet: ��C�C�
Fxont: Depth: Height:
Square Feet; ' Cubic Feet:
Type of Construction: S w� u� (L� � N`� �c� oL Estimated Cost c$ J�� C� C�
.
To Be Completed: ��� 3 / % �
The undersigned hereby makes applicativn for a permit for the work herein
specified, agreeing t� 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 txue and correct.
�c✓�f N��,
DATE: ? �� 3 7 � SIGNATURE: �
(See R�verse Side For Additional Information.) •
�3��� ;�� �'
a �� .���--'' .
�
- 37'� Q
�
BUILDING PERMIT FEE SC�iEllULE
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
agplieant for such permit of fees to the amount herein below set forth and in .
the manner herein provided to-wit:
1dEW CONSTRIJC�ION : Si.ng�.e Family Homes and Garages :$4. 00/1000 cubic f eet
PLAN CHECK: 25 percent of building permit fee.
ADDITIONAL INFORMATIQN
P.
For the gurpose 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 suxface or to the average�
�height of the roof surface of the main gable of a pitched roof.
For����pairs or alterations to an existing structure, the fee shall be at the
rate�of $3.OQ 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, �
VERIFICATION OF FOUNDATION
NOTE; Permits for eonstruction will be issued a mini.mum of 24 hours from the
time of application, to allow for proper rev iew of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceeding with the framing.
CERTI�ICATE OF OCCUPANCY
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 CertificaCe
• of Occupancy has been issued.
Q� \ �
M�� p
M i N
� � -c' 7�
p�� �
�
o� ��
p � yl
� (n
� p ��
� o Q3
.� r M
����
� °�3
�
���
�rt�
r
�
J'c.
�
.--t
Customer
Address
Size
Date
Phone No,
�
�
m
�ito r�dle
� � �
6431 UNIVERSITY AVENUE NE
., a1.y 14, 1976
Mike Mulvaney
�Custom Pools Inc.
701 Excelsior Ave. S.
iiopkins, MN 55343
ANOKA COUNTY
Re: Swimming Pool at 437 Rice Creek Blvd.
Dear-Sirs:
560•3450
FRIDLEY, MINNESOTA 55432
This letter is to make clear this departments requirements for the
swi.mming pool construction at the above address.
1.
2.
3.
4.
5.
6.
� 7.
8.
9.
10.
11.
12.
As indicated, two (2) skimmers approved by the National Sanitation
Foundation will be pravided.
As indicated, three (3) inlets of approved design for fresh and/or
rep�rified water will be provided.
As indicated, a main drain of appraved construction will be provided.
The filter and pump shall be approved by the N.S.F. and be of sufficient
capacity to provide a minimum turnover of at least two (2) times in
24 hours: This department recommends a turnover rate of 6-8 hours.
A deck, a mimimum of 3 feet wide and sloped away from the pool, must
be provided around the entire perimeter of the pool.
The diving area will be acceptable provided there is no overhead
obs tx.uc tion .
A fence or o�Cher suitable barrier, a minimum of six (6) feet high,
that affords no external hand or foot holds and which is impenetrable
by toddlers, must be provided around the entire perimeter of the pool.
All gates and ather accesses shall be equipped with self-closing and
self-1�atching devices which are capable of being locked.
An automatic chlorinator should be provided with a suitable test kit.
All eleCtrical and plumbing installations shall be inspected and
approved by the City Inspection Department.
R11 electrical lines must be 10-20 feet or more away from the pool
surface.
The pool fill spout must be airgapped or protected by a vacumn breaker.
Suitable safety equipment to include but not limited to a ring buoy
and rope that is l�.times the pool diamet�r, and shepards crook pole
must be provided and maintained with the pool at all times.
�
A
page 2
Mike Mulvaney
July 14, 1976
Furthermore, these and any other requirements must meet the provisions of
the Fridley City Code, Section 115, Swimming Pools. The building permit
is approved contingent on final inspections and approval by the City.
If any questions or problerns arise from this letter, please feel free to
contact me at 571-3450, ext. 170.
Sincerely,
:
STEVEN . OLSON
Erinironmental Officer
SJO/bak
c.c. James McClusky
6350 Able St. N.E.
0
0
4,
�_ � y { � %�: � ': ��\ `: �,i��e �,;.
� AWUS4y
'Is—i0��i2 50 --� rS�3i� --__
g-i�i +1
T - —
'— 2 T03-v2• �r 6• -- �--
_ �._ "—
T.�i2' S-��! P�TNQY.10�.2)S
6-i/�
- B Y�6
_ _l_
9-�N - MO LEGIt iIANGE ,EN
I ME�R o�
RETE and
)OLS
'� /ERfORA7E0
WK(T
1•S�'
T .
�� ; r �;:.
SP-1084
FOR ViNYL, F. G., STEEL,
ALUMiNUM atld WQQQ
POOLS
�q�l �'80.� .
� I
SP-1082 2" Cycolac 8ody, adjustable cover sP-���
collar. Tamper-proof cover, basket,
SP-1082-1 j.'/2" weir, Flo-control slide plate. SP-1084�
SP-1082-1R j�/z" Same as SP-1082-1, but with 9Ya" SP-1084•
diameter ROUND cover (not itlust.)
SP- f082-1, SP-1084-1 have 1 r�" pump outlef and 2" equalizer/main drain ouilet.
Same as SP-1082� bUt W�fl e� �
throat, Cycolac face rim (whi1�►#�
gaskets, screws, plus drilla�
a
mounting Nange for wood poo�.
Same as SP-1084-1, but wtth 11�b"
diameter ROUND cover (not itl�.�
Standerd ecrswa �re fo� 3/ 1 d� m�x. wd� Ml�i�w
SP-1085 Wide Track Auto-Sklm i11u�N�bd e
separate pa� insert — No. 30(Al•7B.
• . " ' . �;�y� ��t �i�loy . . . . ,
' �3-8l�-8�9p01. • , . � . • � . '
� , • � �!'iy^..�'S�,i��?i YtC..'Y ��U►'t'tl:ii:� �.i,�.�l ��t� � 1'�:�I�� �'G'S'''e.t.i� • •
� � , ' ... . .
� ,,,,,,,_,,,,�.,,...,,..�. Dopt. at F31daa� phono Sc�•3�►SO
� D�SC�IP7IO2f O: �'101Zr � ���� � 635�� Nr �le Street
hu�Ss:. v.� a�d Lccr:.i�� o! Flxts::.s , ., • .
. � . 1 _. M ', •
l)
Z :w � _ � 7� � =� � 8�i"; �� � 7<' 7�'r
� $ r
N �Y� � �1� ? ��s.. �. � :3�v� �t u ����
:�:r , .
, � :. 1 � nM
4^V "
3:d �
i •� = � -.
Ccar.:s::d alta
• FL:.::o Cc:.:c:s::� Cr?:.c!r.�. , .
s Naa Fi:::`ar+. Old O'�:i.".st
.
�ARTlAl. RATE S�H�DULE
WATt� wY�1.
.
w r.�s tut.
5.aa:
Cc:;.pcol
�
u
: LL^ri8I1;G fl:CTJ'E R1lTES: , NO. R11TE , T07AL '
r•�.�r �x:u:�: . . . . . . . . . �. . . . . . . _..._—,- x s�.a�. s ...._...
........... .�-- x Si.SQ S ..._......,_
flitu:e F�xtuce n;�cning , •
. '. x S 1.50 i ..,...:. _-----
City oi �'ridlcY: .
The uadcrsib^ncd hereby tsukcs s�?�.Icauon tor �z Ftt7Y1i! IG! thC aOT� 1
apecificd, a� tc:n� to do ay u•ork :a ::rict �cco:Car.ct w�l�h tre Cib O��
�::d ruling oi the �p�::r�ent of nuil:l��. s:�d hereby declares �'�a1 s1I t-`►e
,, and teDrescr.4:tions sizted i» :l:i: a�D:lcaL:°� :re irue sr,d co:rR"t' ,
, r''Yid1eY. L�aa 7-29-76
Owner '
Kind oi B�ilding frame
Used as
To �c corpteted ab�ut 8-5-76 --
Estimated Cost. S 10 OC �
F•ra9t tia._ ln�
Old—I�t Flui;ding P�rntit No• �
�� �
. ' Slzr,cd��� • .
. •
. � . � , By ��"'I�t€611568 - -
� 8usin�K.s i'h.+r.e ,ta .
1�W F�x:vre Old Oyer.,n� � ��♦ • • • • • • ..�� . , .
x 53.25 S , .
Gtc!� II �sin . • • • • • � • • • • • • • � • • • a • �..�..�..�r . .
l�'slcr �Iezter'L'p to £r3.000 81'LJ�•••• --------- x;3.CA S .
_ �
�e�+ G:a�ad Run Ol3 S:dr. :..:.... _.._.---- x.1.25 S
i'rct�.c Yla:�T �i�.1:i1� • • � � i � • • • � �! • ....�..`�. i r�•� 'S
il.S :I?:I1G FEi3: ' HO. Rf+ � 707AL �
. tst]Fixtcre: ••••�������••••�•��.......�.�Xs2.� �,. �
. Ad; !tl�aii i'ixtures . . . . . ..... . . . . . �.�...--- x : .75 S �
C:s R�.::e to 1 r?.OGO 8TU ..... ...... ----r---- x 35.00 5----------
. . �
�ovox _ _ '
. .. .
FINRL _ . � _ �/i,� y .
. �
,;s . .
• . .50 S'tate Surch�~ge , •
�..r.?,1:.°.S tt xL.:FAJ►TIONg--P.�:�r !o Coda '. ,
1
•�'itTiyi�0i1 •�� � � � � • • � � • • � � • i � � �.� • • � �.� • • • � �.r � �.� � .� �•� • � ��3S$ 'rrAn ��?�t ar��, ;�.', .
, . 'rQ�r�i+ �*.:.�+ �,.�...�-= .
, , . .
. ,
. • •
.WELL DRILLINO FOR FOUR OENERATIONS
15688 J�rvi: Street N.W., Elk Rive�, MN 55330
� � (612► 427-8100 Fax:. (612) 427-0533
lNCORPORATED
Date: FEBRDARY 29, 1991
MINNESOTA DEPARTMENT OF HEALTH
7l7 SE DELAWARE STREET
DIVISION OF ENV'IRONMENTAL HEALTH .
MINNEAPOLIS, MINNESOTA 55440
ATTN: Mr Jim Nye
(612) 623-5339
SUBJECT: WELL ABANDONMENT
S ITE D IAGR�iM
RE: NOTIFICATION
Dear Mr Nye,
W ELL
NORTH
�
�
LU
J
�
�
This letter is to notify you of a water well in your district that should
be sealed according to the Water Well Construction Code MCAR §4725.2500-2900.
E.H. RENNER b SONS, INC has been notified by the owner of this property or
an interested party and have subsequently submitted to them an estimate for
the sealing of this well under our LICENSE �71015. We have also included
a copy of the current code with our estimate.
In submitting our estimate, the owner may also receive additional estimates
and hire any number of Minnesota licensed water well contractors in the area
to seal this well. However, there is a possibility that this well may not
be properly sealed and thus jeopardize the ground water and Public Health.
E.N. RENNER & SONS, INC. '
reference with the onment
PROPERTY OWNER' JAMES Mc
ADDRESS: 6350 ABLE ST
rovide you this information for future
when submitted. �
F'/ �.,�
PHONE #
DATE g-22—gB
LOCATION: S�/IN HOIISE WELL DIA. l��
DEPTH: 7� � nr less
Sincerely Submitted,
,
Raymond T. Renner V-President
E.H. RENNER & SO , INCORPORATED`
STATE IICENSE`�710T5
CC: CITY OF FRIDLEY
6431 iINIVERSITY AVE. N.E.
FRIDLEY MN. 554 2
A N: DARREL CLARR
Equal Opportunity Empioyer
sue�ecr PERMIT NO.
City of Fridley 2 625 0
AT THE TOP OF THE TWINS gU I L D I N G P E R M I
r
� �
� �
COMMUNITY DEVELOPMENT DIV. �� � � /
r � ~ � PROTECTIVE INSPECTION SEC. � �
� , �'��1 � CITV HALL FRIOLE� 55432 NUMBER pEV. DATE PAGE Of APPROVED BV
�""�' �'' 612-571-3450 9�0-F�5 6/16/98 � �
JOB ADDRESS 6350 Able Street NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. S,6 6 Florence Park SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Helmu.t Tornquist h�50 Able Street NE 571-49ll
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO.
Steve Bodinski Construction 2215 135 Ln NW, Andover, MN 55304 754-8917 20019069
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZiP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CIASS OF WORK
O NEW O ADDITION ❑ ALTERATION t� REPAiR ❑ MOVE O REMOVE
8 OESCRIBE WORK
Reroof House & Garage (28 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING.
VENTILATING Ofi AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WOHK Ofi CONSTRUCTION 2ONING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I MEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICA710N 1 STALLS GAqAGES
AND KNOW THE SAME TO BE TiiUE ANO CORNEC7. ALL PROVISIONS OF LAWS VAIUATION SURTAX
AND OROINANCES GOVEFNING THIS TVPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �2�335 �l.IG
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEI THE pEqMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW FiEGULAT�NG CON- @
STRUCTIO HE P RfORM CE OF CONSTRUCiION. y�74.7.5 Fire .5�.' �2.36
�PLAN CHECK fEE TOTAL FEE
'� License SC $5.00 $83.27
S�GNATUREOFCONTFACTORORAUTMORIZEDAGENT � IDATEI rr��/`�` HEN PROPER VALIOATED THIS IS V UR PERMIT
\ /
SiGNATUAEOFOWNEAiIFOWNERBUILOERi IDATEI 1 � � (
B G �NSP �iFTE
NEW
ADDN
ALTER
�]
[]
[l
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
1 �-� �
0_�O ��
�
ConstructionAddress: � �j � � / � r',t' � ��
Legal Description: L> � �� ��j �P j / _ ,
Owner Name & Address: C' r^ �� � f� U i 5� Tel. # 5`%/" ��'��
Contractor: (JP �►.n 5�►" o n S�'�; MN LICENSE #� G 0 j J� C� �
Address: at`� (S /'3 S T� ��n< <%/Gci. ,GQ•�dvc��� l�h. �'S3�f' Tel. # �% Sl/�- ��j'/�
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 IMPROVEMENT
Length ' Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
.
'��'� �aes ,
Construction Type: l��� OrT �� �P��� Estimated Cost: $ �-3��
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: "' / � -��, APPLICANT: --- Tel. �#• ~%s� ����
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Chazge
TOTAL
STIPULATIONS:
� � S�
$ �-3 �
$ l. l G,
$
$ S U4
$
$
$
$
$ ���
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.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 [ ]
�...,�
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official 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
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000 �
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
0
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and inciuding $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000 �
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1, 000 or fraction thereof _
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Altemate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $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 it has been constructed
will be required before proceeding with the framing.
• _..
Building
Inspections
763-572-3604
DATE C — � � �%
SITE ADDRESS ��
T'HIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNIIT TYPE
TYPE OF WORK:
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FR�DLEY
YOUR E-MAIL ADDRESS
OWNER
Permit No.:
Received By:_
Date Rec'd: �
�
ADDRESS: lSJ �(�— ,/�-�-fi�Le `7�" CITY Q STAT��ZIP
PHONE: '�J 2 ��,� `��
NAME:
STATE LICENSE # G.cJ�- E'3CP� ATE ' "��
ADDRESS: —" CTfY STATE
���-�`� �� L ,y �v-- -����
PHONE
❑ NEw
FAX
FAMILY O TWO FAMILY O TOWNHOUSE
DETAILED DESCRIPTION OF WORK
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, insta.11ation or replacement of a residential fixture, excluding the fixtures. (This shoWd reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT VJF�RE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOV�
BATH S1NK/LAV FLOOR DRAII�tS SHOWER WATER PIPING
BATH1'UB GAS PIPING (x� ctrt't�c� SWIMIviING POOL � WATER SOFTNER ($35)
CLOTHES WASHER KTfCHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
DISHWASHER LA[7NDRY TRAY WATER HEATER ($35) FOR IRRIGATION
— WATER METER _ OTHER
Permit Fee
TOTAL DUE
$ Number of fixtures @ $10.00 x $10.00 = $
.50 Number of fixtures @ $15.00 x $15.00 = $
$ Number of fixtures @ $35.00 / x $35.00 = $�
State Surcharge = $ 50
Tota1= $ ��
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 applicatio for a permit and work is not to start without a permit; that the work will be in accor ce with the
approved plan in the case of a ork which requires review and approval of plans.
SIGNATURE OF APPLICANT /O,/ % ,, PRIN't NAME �cQ v�°�' �� DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
�63) 572-3604 FAX: (763) 571-1287
REPRINTED ON 1/12/2006
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
: 6350 ABLE ST NE
: 143024410098
: UNAVAILABLE
: LOT BLOCK
: PLUMBING
: RESIDENTIAL
: X ALTERATION
NOTE: WATER SOFTNER
# WATER TRMT APPLIANCES
APPLICANT
SHILOAH WATER CO
7319 166TH AVE NW
RAMSEY, MN 55303-
(763) 753-9244°
000409WC
OWNER
TORNQUIST HELMUT A
6350 ABLE ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp.
1
PERMIT NO.: 2006-00010
DATE ISSUED: Ol/04/2006
WATER TREATMENT APPLIANCE
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 11004
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
35.00
0.50
35.50