AF - 46994APP��a� �'ows�' Ma+Ks and HsaNeg. Cooling, Yenh'lotioe, R��ig�r�a�ion a�d
Air Condhioning SYst�nrs ond Devic�s
PARTIAL RATE SCHEDULE
GRAV3TY WARM AIA: 1l11TE TO?AL
lh�rnace 3het1 dc Duct Work . . . . . . . . . . . . . . . . . . a10.00 �
Replacement oi P1�rnace . : . . . 6.00 �
Repairs dc Alterations—up to =500.00 6.00 S -- -.-.—
Repairs di Alterationa each a�.:500.00 . 3.W i�-----
1iECH. W11RlR 1►ZA
Furnace SheA dc Dnct Work to 190,000 BTfT . . . . . . . . . . . a10.00 �_. ✓
each add Q0,000 BTU . . ........... .. . .. .. . . 3.1x► ; ✓
RepLcement of Ftirnace . . . . . 6.00 �
Repairs dc Alterationa--up Eo i500.00 6.00 ;
Repairs & Alterations each add. =500.00 g,pp ;
81'EAb[ or HOT WATEA SYaTE1[
Ftirnace Shell dc Lines—to 400 sq. tt. EDR Steam �10.00 $. __
Ftunace Shell dc Line—to 640 sq. ft. EDR Hot Water 20.00 s_
Each add. 200 aq. tt. FDR SEeam R,(1�► �__ ____ __
Each add. 320 sq. ft. EDR Hot Water 3,pp �_
OIL BIIRNER—to 3 gal. per hour g,pp a _
over 3 gal. per hour�e Fee Schedule
GAS BIIitIfER (up to 199.000 BTU) . . . . . 6.00 ; ✓�
wer 199,000 B'I`U See F« Seludub
GA8 FITTING FEEB: ' I�O AATE TOTAL
ist 3 F�xtures . xE Z00 E
Additlonal P9xtures x .�6 i
Gas Rauge to 199,OOb .. s= 6.0� _ —
AIR COIfDITIOlfI11G � ✓
F]►li HS1►TIItG sTSZEM SM PN /elMdab ^�
VEIITII.AT�6 sYaTEM � r�—^
ALTERATIOI�s ! AEPAIAS ?O?11L !a6 S ,
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The undersi�ed haeby makes application for a permit for the worl� hereir
specified, agreeing to do all work in strict accordance with the City Ordinance:
and ruling of the Department of Buildings. and hereby declares that sI! the fact�
aad representations stated in this application are true and correct.
1�id1eY. Mian- �� � `� 3 �, 1� � %
Owner �..-�`'�t�..�,�tJ l'.a....tt.�t..�..-.e..�
Kind of Building .__ v
Use� as . _ _. _.- - � -- �� ��4�.st�
To be completed about�a'—� '� � 12 %-��
Estimated Cost, 5----,L�-�---� D d�__. U O -- -
Building Perm3t No. P•rmit No. .p< C:�
DE6CAIP'TIOI� OF WOR�
HEATING or POWEii pi,ADiTB—gteaa�. gat Water� Wana Air—No_
Trade Name 1, —�-,,c�r,�u�-,�- —� C�s-�' �'�` � 51.3 %
.r ( � g�ze N��,rn �. �i � ':� r �
Capacity�7TT b D� gq. M, E.D,g gTU Ap.
Tota1 connectea Loaa / 7P ,/ o C) xlna ot lwe, ���—�m--cc�J
BURNER — TYsde Name 3ize No
`� CaWdb� 3q. !'t. Lr.DR - BT(1 i,�P,
�C
(REMARKS—OVER)
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City of Friclley, Minn.
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
Date: _._..NQUet��x:__2�:��71
.s y�.� -
�, �8
Owner: _.Ail.9.k.�._.�.ountv ---...y__.._._._ Builder �F1 p�i ew CQI1S.7�.�3.Ct"; nn Tn` _
Aaa�s _._Au.Qka.._�szuaaz�r....�u�xx_..�I.Q�.�____.____..._�.�. AaaFess .._.Z�i4.l�. - Z�Av�,n � No t, Mg.�.g_
561-6780 560-8233 �
LOCATION OF BUILDfNG
No. .--.---_66�3----_..... Street _...��t�u� _S t�.ee.�....�i�.�...._�._.•--.._._.._ Part of Lot _ _ --- _ _
Lot 19-�-2IIr2L.__ Block __._...._._.._._._3...._.._ ..........:.._...._.:._ Addition or Sub-Division __._Oak�:�roVe Add��on
Corner Lot -•------...---_-._--•-__ Inside Lot ••_--_._......_.__�_._.._ Setback _.:.__..__.____._._._ Sideyard
Sewer Elevation ..----------._._...--•-----------------'•-----.__.:__.�------_-•__.:_.:. Foundation Elevation _..._ ------..-------
DESCRtPT10N OF BUILDING
To � v�a �:
Daytime Activity__Center �nt ...78 � . De th 28 � Height .:..�0 � � �. � 1512' � � 24,192
p._._..._...._..__
...�.__-_--•---••------•-------------•--.._ Front .__._.__._. Depth Height �_..__._.. Sq. Ft. _.� Cu. F�
Type of Construction __� Frame .._, Est. Cost _._.�84s.000., 00 �_ To be Completed June 1. 1972
Stipulation: Subject to attached letter from Anoka County concerning drainage.
Subject to Health Insgector's stipulations on memo dat+�d Dec. 21, 1970.
All construction fees waived by City Council on December 7, 1970.
In consideration of the issuance to me of a pe ca ruct the building
the proposed work in accordance with the descripti above set forth and in ca
ordinances of the city of Fridiey. ,. /y
I agree to do
��� E�
In consideration of the payment of a fee of $_. NO FEE __, permit is hereby granted to E1Vigw Corist7'txctiOn
__.._....__.._..__.._._._ ........................._._._ to construct the building or addition as described above. This permit is graated upamt
the express condition that the person to whom it is granted and his agents, employees and workmen, in all ov�k
done in, around and upon said building, or any part thereof, shall conform in all respects •to the ordinauCes OL
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildiIIgS
pyithin the city limits and this permit may be revoked at any time upon violation of any of the provisions of Said
ox�dii►ances.
il�������?��� � � Stlilding Insp¢CtaoC
HANK MUHICH
NOTICE:
This psrmit does not cover ths eonstruction, installation for wiring, plumbing, gas heafing, aswet� or waler. B� sur� fo sN
ths Building Inspector fo� separata psrmits for these ifems.
:i
� . '
♦
�� �,s�, �. ��_'�
COUNTY OF ANOKA
Oftice of the County Board of Commissioners
COURT HOUSE --- 421-4760 --- ANOKA, MINNE5�TA 55303
November 23, 1971
Mr. Nasim Qureshi
Engineer
City of Fridley
6431 University Avenue N. E.
Fridley, Minnesota 55421
Re: Proposed Daytime Activity
Center - 67th and Arthur -
Dear Mr. Qureshi:
This letter is written pursuant to a conversation between
your office and Mr. Roger Patch on November 22, 1971 in
which the question of drainage with respect to the above-
referenced project was discussed.
Pursuant to Mr. Patch's recommendation, as architect for the
project, you may construe this letter as a commitment of
Anoka County to maintain the drainage dry well in proper
working order and further that the county will not in any
way contend liability or responsibility on the part of the
City of Fridley with respect to drainage resulting from
proceeding with the plan as submitted by the county.
Sincerely,
� _.
Bernard E. Steffe
Anoka County Administrator
BES:lsw
CC: Commis�i�er= Mil�e Q'�� nnon
Mr. Ro�er Patc�h"` ,
ElView Construction m�any
Mr. Clarence Belisle, Fridley
Building Inspector
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RIIIL�ING PE PR1IT
CITY OF FRIDLEY
NOTE: Appliaant ehould
obtain building permit
proCedure iII�n�nnn� n!n ,_
�� from Building Inapection
BUII.DIIt: ,�� V/Cbv ,��„�r�Tl�w-cf/vN 1�rC . � Department Secretary.
ADDRESS; %GO/ %a.�-¢� N NOTE: A Certified Survey of the lot,
Q f�
� 3treet C�ty Zip Code showing the location of the foundati n,
TFLEPHONE: ,,s'G/-�,�$+o �d.��,a3 once it has beea constxuated, w�,11 be
.- required before proceeding wi,th the
$ome Eusiness
f raming .
PROPERTY OWNII�( S) I� No�ica �� '
ADDRFSS(ES�
Street " City
$treet City Zip Code
TELEP'HONE NQ.(S)
Home Businese
ING
Pxoperty Location on Street //d�KTKW � �-+
or E�act Street Addreae (if any): G� �3 �Ir�ir�rt .�3' ....-.,...
e
Legal Deecrigtion o�' Property:
� I b ! i
Total Area of Property �S,OQ eq. ft. Preeent Zonir�g Clasaification,��
DESCRIPTION OF BUILDING �
_ � . � 1 _.
Proposed Buiiding IIse:
.
�ilding D�.a►en�ione:
�
c�a�p"
bo,�s�; � y' ��►�,�, xy' - � � _
Front "%� Depth �.8 Heig�ht�
3qu�ure Ft. �S I Cubia Ft. /9�*
Type ot Conetruation: s�t � �
Estiaaated Gaet �'}�0_b_'� To Be Completed ��, 9i'Z- �
, � c. _ �
/ _ -+i
DATEs���, o . «� � , wPPLICANT' 3 3IGNAT�IR _ ' �
% ��v ,4 � /,C�i=u`� /�'�: p 7/� �i' U v� H T' h� O N�� C � �v C� 5 R S%Ti 6/lJ w i -U/L�tc>
c'aNS'T�vc�-/o/t/ - ti'�v, 1 �, l`'�/ ��f�"�` /�R��f �vi/ L s v��/ �'�Gv
Pti�Als � 5/�ow�ti�c' ���,SIi�L/= F_�1�1: V Glf�'�,� s �- /��P�f/�s�/k-G,� >'�-��/�'
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, � e ` ' i�'`JN-RES.T..DF�NT�Ai, BJILDI.NG P�MIT
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CTTY OF FRIDL�,'Y
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ZONZNG: �— /
VARIANCE REQUIRID: �—�"`�
SPECIAL IISE REQUIREf): --
PLOT PLAN: TOTAL AREA GRADE ELEVATION SFfI'
i4 s � �
ADDRESS• -
LEGAL DESCRIPTION: L.. ;5-,�0-,,�� �
BACKS: FRONT YARD SIDE YARD REAR YARD
��JzvC� 59�'1` P�NR �&�7Gf ¢ �1��-1� 3� �
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SUBMIT T0: BLTILDiNG BOARD BOARD OF APPEALS PLAN. COMM. COUNCIL
APPROVAL DATE: %�' - fj
/2 —%�'% O
� � REMARKS: .
w� FIRE REQUIRIIKENTS: F� SHALL FIRE PRESiENTION BUREAU F�CITS (dates App)
va '
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� INSIDE UTILITIES: PLUNIDING VENT H� 'ING ELECTRICAL
H �, Date Approved : �%� . �� �°-"
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OUTSIDE UTILITIES
& SITE DEVELOPMENT:
Date Approved
City Engineer
WATER SEWER ELE'V CURBIIvv DRAINAGE SCREENING & PLANTING
fr s�f',q T d�r 7o C3F ,a�/�iQavaO
�4nA�ove� R�pAo%v
P�.¢R/ O�Y �=A76 �y S,vsPvt�`ioN C�fTr
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Sewer Co.nne�tion Char�e �;��' Receipt No.
Permit Fee & Plan Check ��� r��,�� Receipt No.
� Less Deposit �� � Receipt No.
�, Net Permit Fee Due 1f� �eipt No.
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SPECIAL ASSESSMEN�PS: "
IF LATE�tAL ASSESSMENTS HAVE NOT BEEN PLACED ON THIS PROPERTY, AN AGREF�KENT MUST BE
SIGNED, AGR ING TO ASSUME SUCH LATII�AL ASSESSMENTS BEFORE A PERMIT WILL BE ISSUID.
_ ,�v AGRF�EMENT NECESSARY
Finance irector AGREFMENT UNNECESSARY ��P
Regiete'red Engineer's Stamp �' Legal Deacription
(A�
(B)
FOUNDATION P�tMIT
Building ficial
FINAL APPROVAL ` `
Cit En ineer
FINAL APPROVAL
Check �
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Building Official
NOTE: Ea.sements, R/W, Special Agreements
Y � I�J � ��'7 l DATE:
CERTIFICATE OF OCCUPANCY:
PARTIAL:
REh1ARKS :
DATE:
FINAL:
RII�IARKS :
DATE:
a�.....�.......�...�..��..,�..,,.�..�... e.� _.— _"'" ` .
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Fire Phone 560- I I I 0
CITY OF FRIDLEY
Bureau of Fire Prevention
6431 University Avenue N. E., Fridley
MINNEAPOLIS, MINN. 55421
ROBERT D. ALDRICH, Chief
Memo To: Henry R. Muhich, Building Official 71-1-
From . Robert D. Aldrich, Chief, Bureau of Fire Prevention
Date . January 5, 1971
Subject: Anoka County Day Care Center
I have reviewed the plans for the proposed construction and note
the following:
Zoning - Not applicable
Occupancy Class - Class "C" UBC Table 5-A
Construction 7ype - Typ� III - One hour
Area - 3,300 square feet approximately - assembly building
600 square feet approximately - attached garage
Occupant Load - 3300 divided by 60 equals 55 UBC Table 33-A
(Nurseries for Children - day care)
Plans are approved as submitted
RDA:et
YOLI Can Help - STOP Fires -
Bus. Phone 560-3450
,'
SAVE Lives
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M�.nn�ape��isx �Ii����t� SS�s�3
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Th� �+��l�ri� � �ue �a� t'h� �i�+�tx�.���. ��'m:i� ��r �i� �bo�►'� �ddse�� :
���'ic� �et�t? $�.�.fl�3
Fe�ecle� Z�Q �.t?�
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W��+�� He���r �.0t�
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3�i�h�ara�h+�r �.. �I1�
4ss�lets 67 I3. �t�
�a��� lt3 1ii.��
Elec. �t ��3 �,W � lti. {�E3
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A�s�� �'xid �ii.�A
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���ARA E��L'�ER.
El�c�r`i��� II�p��ts�"
�.,�, . � Y �7 $ii4:i^l+.ci �i �:'•i.I3:�� . ; I' . .
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° ,�• CERTIFICATE OF OCCUPANCY �1����
� � .,_ -
location ��33 Axthu�' S�reeC I4.E. Building Permit No. 11�258
Fridley, Minn., Juiy 7 19 72 .
This certifies that we have inspected the building at the above location, situated on Lot� 1A� ��, t1.T�'�
Block � t7�tk t'rr,ve Addition to Fridley, and find that the same complies, to the —
best of our knowledge and belief, with all the requiremen ts of the Buifding Ordinances of the city relating thereto,
and permission is hereby given for the occupancy of said building, in whole or in part, in the manner and for the
purposes herein below specified.
���- Floor� to be occupied for C�iiidrer.s 'Day Ac�ivity Ce t�r
Floor to be occupied for
Date Approved - F P B
A'�, r.ldxicai
Plumb. & Heating Ci#y ���I{ E�`.g7c.
Lv'. ��t„�,�.n �z. (�ur�sh�
Elect. -- _ Bldg. Insp.
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560-3450
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ANOKA COUNTY �
6431 UNIVERSITY AVENUE NE May 21, 1974
FRIDLEY, MINNESOTA 55421
Comstock Electric, Inc.
10136 Central Avenue N.E.
Minneapolis, Minnesota 55433
Re: Eleetrical Permit Shorta,ge
6633 Arthur Street N.E.
(Second Notice)
Dear Sirs:
The following is due for the electrical work done at the above address.
Our first letter was sent on July 6, 1972 and we have not heard an1�thing
from you on this. Therefore, we are placing a double fee on this shortage.
: Service 400 $11.00
Feeder 200 6.00
30 4.00
Water Heater 3.00
Range & Oven 3.00
Disposal 1.00
Dishwasher 1.00
Outlets 67 13.50.
Sockets 70 10.25 �
Elec. Heat 28 KW 10.00
$62.75 �
• AMOUNT PAID 36050
DOUBLE FEE AMOUNT DUE $52.50
If we•don't receive this amount within IO days of the date of this
letter, we will be forced to turn this over to the City Attorney for
collection.
Sincerely,
LE/mh
LEONARD EICHMILLER '•..
Electrical Inspector �
I
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�!'�ar�'IaM� aad H�q. Cooling, 1/�n�it�tioa. Rf1�iq�roNoo �d
Air Condttio�i�g S�s and Devic�s
P�AR � IA�. �i� SChiE�ULE
�IIAY!7'T NAlW AIR: 11J1Ti TOTAL
1�1�rnsce 36et1 � D��ct F •asr� . . . . . . . . . . . =18.00 �
ReFtacernent ot llga�c� . . . 6.00 �
Repairs & Alterations--r;p Co SS00.00 6.00 E—_. -- -.._
Repairs � AltrraUone e;�r;� add. fb00.00 . 3.W �-----. ----
D�6C�L w�1t�t AU
l4u�nace Shell dt D�u.�t �:.��c �� l�,� �'�t;
e�ch add. AO,�:s �'."�� .. ... ... .. ....
�P�t oi Fl�rnsce .
x�win a� an�T.c�on.--w �o ssoo.00
Rep�ira & Alteratioos each add. �.i00.00
. �10.00 �_
3.t1cf S
6.00 $
�.00 �
3.OU �
�°!'LAM � ROT rV>TER �TE�[
flsrnace Shel1 d� Lines—to �00 sq. t!. IDR Steam s20.00 S ---
Ftirnace She11 dr I.ine--to 6!0 sq. ft. EDA Ii� Water 10.00 �.
Each add. !00 sq. tt. EDR Ste�m A.AfI �.. __._.
L�ach a�. 3Z0 sq. it. IDR Hot Water $.00 j�._
OIL s�ANLR—to � Sal. P�' hour 8.0� i .—
aver 3 pL per hour—See �'ee 3c6ed�le
GAS sUR1�LA �up to i�,000 BTUl . . . . 6`00 � _�-; �`"t/
oMtr 190,000 BTt1 � F» ieMdul�
GJ1s FI'RII�G FEE�: lf0 lU►1'L TOT1U.
lst 3 l�xturrs . xf 200 =�• �J
Additional lixtwea z .76 i
Gas Ran�e to 1l9.00� . =i 6�0p i —
11IR
TAlf HE�TtltO slsZD[
Y�fITI1.A?1wa SriTE�1
ALTSAATiOIh ! IILPJ1Illi
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ra�u. ! �- I - 2 �
n.D�. � �v. r�. eeo-�eo
.. ._...
citr at 1�'rtaley:
The unciersigoed hereby makes applicatton for a permit !or tfig� �raa� herei�
specified, agreeieag to do alt work in stric.i �ee�tia� vvith �� G�gy c�.,�
as�d ruling of the Depat•tment o4 BvildinBs, and herelbg declsres ti�a�t �i�' 4,�a� ER��`,,;.
aad representaUons sta4ed in tRis application are trve and c�eet.
liidleY. Minn _.__� Eg _
0
Kind of Huildin�
vxd a� . - - _ . -- - --- -
To be compkted about
Estimatcd Cost, i-.___._... .. _._
ae—r�.. 8,�� � r�. �.��� �o. �"4y �
��
�ATING oe POAER Hot Water� Aarm Air-No
Ttide Ns�ne.�ss� " _ sise �- F �� �(
Cap�cit�__�..�._ Sq; !t E.D R BT�T HB
Total Connectsd Lwd Etad at fi�e
BURNLH - 1Y�de Name gise �
Gqcib 8q. !'t LDR BTU �
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TOTai. rR � ,�• ��Qicm�i L��! —
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; , �. . _ � $ .5�1 ��O.c,r.z'`_'*y - s�s r�o.. x�,z r- ��, 3 �
a�� ,�-'.."vt
• q/MA�Rf-OYtRj
sue�ecr T NO.
c�ty of Fridley ^2 7 2 5 5
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
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� �` _��� COMMUNITY DEVELOPMENT DIV. R�/_ �(`j/
r � V � PROTECTIVE INSPECTION SEC. Jy[(�f v
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1 � �
l.--• w �"';.� CITY HAII FFIDLE� 55132 NuMeeA REV OATE PAGE Oi AVPROVED 8v
i ''� 612-571-3450 9t0-F15 8/18/98 � �
108 ADDRESS 6633 Arthur Street NE
t LEGAL LOT NO. BLOCK 7RACT OR AODITION SEE ATTACHED
DESCR. 9,20,21 3 Oak Grove Addition SNEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Brad Peterson 572-1642
3 CONTqACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Ri ht Wa Roofin Inc. 1200 E. 79th St. Blo min -
4 ARCHITECt OR DESIGNER MAIL ADDRESS 21P PMONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PMONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION O ALTERATION �x REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (31 Sq) Tear-off �
9 CHANGE OF USE FROM TO
STIPUlAT10NS
Underlayment must comply with the State Building Code.
TYPEOFCONST. QCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PEFiMITS ARE REQUtRED FOR ELECTAICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULI AND VOID IF WORK OR CONSTRUCT►ON ZONING SO. FT. CU. FT.
AUTHORI2ED 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. DWIG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION STAILS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOFK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2585 1.29
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANV OTNEF STATE OR LOCAL LAW qEGULATING CON-
ST�CTION OR THE PERFORMANCE OF CONSTRUCTION. ,'�[ 7�F.75 ire SC Z.SH
j. �/,��� ��� � PLAN CMECK FEE TOT l FEE
_ C Lice 5.0 3.62
SIGNAIUAE OF CON'RACiOA OR AUTMOAIZED AGENT IDAT � EN ROP V ALID THIS IS V UR R IT
l °
SiGNnTUREO:OWNEAi�FOWNERBUiLDERi IOATEI B iNSP � TE
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ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: (p��j� � h �(��
Legal Description:
Effective 1/1/98
J�
��a
Owner Name & Address: �j�''(,�, p..Q�-Q,(�pn Tel. #��2- �(�12.
Contractor: ��C ��- %U(',t,�,1 (ZC�D�h4 MN LICENSE # �n 3QQq'
Address: � �U E . �-Q'�'� ��- . Tel. # �'S��O�G
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: t.Pl:�rl_ G�, �1�,.� ►e�.C�t9_�`� J
Construction Type: �� � Estimated Cost: $���� ��BS-�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: $ �� APPLICANT: � (�j�����, ��LA� TeL #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �y. �.�
� $ �-S �
$ �-�9
$
$ ,� �
$
$
$
$
$ �� �
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
Inspectio�s
763 -5 72-3 604
763-502-4977 FAX
DATE 7 " oZ � ' �
SITE ,ADDRESS � .G ,j �J
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-09
•Y'OrUR E-MAIL ADDRESS
'�1.G .
� OWNER ❑CONTRACTOR
� I��—t'� r' S �
33 P��r`f�� r
- SFs6-6oa
STATE LICENSE
Permit No.:
Received By: � -�----
D��°�kU L 2 4 2009
Y` ���� y STATE I'�n ZiP sS 43vZ
EXP DATE
ADDRESS: CITY
PHONE FAX
� SINGLE FAMILYMEW CONSTRUCTION SIZE
0 TWO FAMILYMEW CONSTRUC'fION STORIES
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
O NEW HOME CONSTRUCTION ❑ ADDITION
� MAINTENANCE/REPAIR ❑ REMODELMG
ATE ZIP,
DESCRIBE WORK BEMG DONE: �`r� v� u1 /� )!
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SID G
❑ Vinyl
❑ Alaminum
❑ Other
O HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
BASEMENT REMODELING SUBMIT:
I . Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
OSoffit ADDITIONS. & PORCHES SUBMIT:
D Trim 1. Site Plan/Survey showing the existing structures
❑ Fascia and proposed project.
2. Two sets of conswction plans
I WINDOWS 3. Energy Caiculations
� IN EXISTING OPENINGS ❑Yes �No LOCATION OF WINDOWS
I OR FOR NEW OPENINGS-DESCRIBE SIZE OF
� 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
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow ^
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ See Back Page for Fee Schedule
$ 65°/a of Building Perrr►it Fee
$ .001 times the total job valuation
$ .0005 x Permit Valuation Minimum $.50
$ $5.00 (State Licensed Residential Contractors)
$ $20g0 �er SAC Unit (Plans to MWCC for determination)
$ � , " � R` ft+6ft=�Q,75 ftx$22=$.f+5y�,�
$ $450 Conservation Plan Review
$ Fee Determined by Engineering .
$ ,�-�-�— Agreement necessary ( ) Non Necessary ( )
$ �< <U ��CJ Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VAL1D 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 i nd work is not to start without a permit on site; that the work wil) be in accordance with the
approved plan in the cas .of ork ich ires review and approval of plans.
SIGNATURE OF APPL[CAN�' /�,J PRINT NAME LJ �"� �.��'E' �'S� �'1 DATE -� -a'T— ^ �/
Page 2- Building Residential Application
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 FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 151$500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for IS` $2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$25,000
$25,001 to $50,000 $391.25 for ls` $25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for ls` $50,000 plus $7 for each additional $1,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 15` $500,000 plus $4.75 for each additional �1,000 or
fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 for the 1 S` $1,000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION