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F;E� �0 G;�TE
SUBJEC7:
L
?G�L?C S:OI:i;S ';i:l!'�.':A'�CE UiVi�:(�!
U',Y 0� F;',fuLi.Y
7hanas Culbert, �ssi;tant Engir.cer
kalph Yolkr.;�r„ Superintender,L ot Public sbrRs
kay 12, 1977
b:ater Z Sev:zr Services Instal'zd - 1977 Street ?roject
63rd Avrnue (Lr�� l, Elcck 2, No:;re Lr.ke Hi,hlands
srd :.cCiticr,) - ;ewer Sr_rvice:
t4ate�rial: 20 ft. 4" cast iron pipe @ 51.50
�er ft. . . . . . . . . b 30..00
ki;c. 1•.ateriai - ce.,ent, �i�tin;s,
Eid5t1C %�, GtC. . . . . . . . �O.CO
Eqcip.: 1 backhse (2 hrs.j � 525.00 per hr. 2GO.GG
Labor: 's ren (8 hrs.) C� 59.42 per nr. .. 226.C8
TOT:,L . . �506.Ua
63rd F,ven�e (Lot 1, Eloc'r. 2, "{�cre Lake Hiehiznds
�rC kaciLicn-; - b;ater Serv:te:
;^aterial :
Equi;,.:
Lator:
l - 14-�/4 corporziion . . . . . . . S Z.60
1 Curb stop B22-�4f1 . . . . . . . . 20.17
i kcd - 65" . . . . . . . . . . . . 5.25
1 �tandpipe cr curb stop . . . . . . 13.�0
1:,0 ft. i" K-cc;,;.;:r C� Si.27 p�r fc. 19�.50
1 k;ackhce (9-1/2 hrs.} C� 525.00 .. 2"s7.50
Ford frcnt-end ;oader (5-1/2 'r�rs.)
[ �2�.G0 p2r hr. . . . . . . . 137.50
4 r,en (9-1/2 hrs.) C+ 59.42 . ... 357.5c
70TAL . . �y70.G3
TOTkI FG� Wl',7EF. Z SEWER SEF.VICES .. 51,476.16
^r.el �?oad (Lr,t 2, Blr,ck 7, Erco's First
Gater znd :e:i�r �r_rvice,:
f�a,�rial: EO ft. 4" pla>�ic pi;,e C 5GC
��f ��. . . . . . . . . . . . S ��.�J
';i sc. :;a teri al . . . . . . . . . . . 50.00
1 blater service . . . . . . . i25.0u
Ecuip.: 7 bac�ho2 (9 brs.j � 525.G0 .... 225.00
Lator: h�en (9 hrs.) @,5.42 per hr. .. 339.12
T07f,L . . 5 765 • 12
C��anGC'i �'.G3!� �LO: u� f'.'.CCi: �, Erco' : First Additior)
-'--- -----
l��eter dfid .�.C'+lui $CY'V1CC`.::
hlaterial: 60 ft. 4" plastic pipe �:,OC .... 5 30.00
I4isc. 1•iaterial . . . . . . . . . . . .50.CG
1 'dater service . . . 125.G0
Equip.: 1 backhce (9 hrs.) (� 525.U0 . 225.00
�.acor: . 4 ren (9 nrs.) C+ :5.�.2 pzr hr. . 33�.12
7CThl . . 5 7i;l.l[
RICE CRF.EK WATGRSHED DISTR.ICT
SUITE 177, ARDF.N PLAZA kCWn Permit No. 83-37
3585 NORTH LE;CIN�TOiV AVF.NIJG � cc: City of Fridle�✓�
ARDGN kIILLS, MINCIGSOTA 55112
E.A. Nickok & Associates
PF.R'1IT RCWD File
Permit Apnlication No. 83-37 Frank M. Langenfeld & Sons, Inc.
Issued to: FML, Inc., Box 96, Newport, MN 55055
Location: Northeast quadrant of the intersection of Mississippi Street
and Channel Road, Fridley.
Purnose: Approval of a Final Site Drainage Plan for construction of three
four-plex residential units on a 1.28+ acre site.
At their meetinp, on March 28, 1984 , the Board of Managers of the
Rice Creek Fiatershed District reviewed your nermit application and the rec
ommendation of the District Eng,ineer together o�ith the followin� exhibits:
1. Permit Application dated April 12, 1983.
2. Runoff Calculations prepared by Suburban Engineering, Inc. and received
April 15, 1983.
3. Watershed Exhibit prepared by Suburban Engineering, Inc., and last revised
November 4, 1983.
4. Quit Claim Deed, dated February 16, 1984.
They found the nroject as nlanned to be in accordance with the Rules and
Regulations, and Guidelines of the District and therefore approved the
permit as requested, with the followin� stipulations:
NOf�E
A followup inspection will be conducted at the project site to assure com-
pliance with all agreements, terms and/or stipulations to this Permit. Fai
ure to comply with the foregoing may result in rescission of the Permit, a
is in violation of Chaoter 112.89 MSA, a misdemeanor.
This document is not transferable, and is valid for one (1) year after the
date of issuance. No construction is authorized beyond expiration date.
If Permittee requires more time to comnlete construction, a renewal of the
Permit will be necessary.
Please contact us at 433-0634 when the project is about to cor.rtnence so an
inspector may view the work in progress. The enclosed Ocaner's Certificati
must be forwarded within 10 days of nroject com�letion.
Date of Issue: May 11. 1984 '�X�t-a-�.(P NC i'✓ e/r�/ti`�
Ji'residen , oar o nagers
Form C11-82
PLANTING SCHEDULE
PAOJEGT � !l /; -. ; ;� C ( . . .
4DGATION� -' � .l �f � �. , • �-��' •
�
OATE � � � �
KEY �OUAN.i BCIENTIFIC COMMON 12E METM.�
/ T�„ . o� �F'., . ,_ ..
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N° 645
0� CITV OF FRI�LEY !�`'�''�N��
„ .,, y
PUBLIC WORKS DEPARTMENT
TAPPING APPLICATION AND PERhIIT
FOR INSTALLATION OF WATER & SEWER SERVICE
I) This form to be completed before a tap is made to any existing water or
sewet line.
Lot �', 1�� � `� Block � Addition � �c c:' � ���) -� ��` .
Address l j.3y ����:� iZriC. �v'� /L%���
Owner � � /�l'
Plumber ti^� � � '
CHARGES TO BE PAID BEFOR TAP IS MADE — WHERE
ASSESSMENT HAS NOT BEEN LEVIED AGAINST PROPERTY
II) Water & sewer connection pe�mit must be registered before this Tapping
Permit can be issued.
City supplies all material and lab for 1" �Ot under water tap. Con-
tractor supplies al] material and la fts�' water tap over 1", and all
sewer taps. � a � `(
�� v� r`'
WATER TAP: ��!-�� M rials Used: S���' �� ��
�
�J� �r .. - ��
� � ^�� S t Patch: z : S�°'
� � � �j��"`' � i ,��' � ���� / �C1 L' ;
� C � � ~' TOTAL: 5 ` -
l�'��~ SEWERTA� StreetPatch: x . $
III) If this property has not paid a full Lateral Charge for its share of the
water and sewer system, additional charges wil] be placed against it.
This will be in addition to the normal connection and tapping permits,
meter deposits, etc.
Water __
ASSESSMENTS TO BE LEVIED: Lateral: S
Sewet Lateral: S/ 5" l� ,/�. l;�
TOTAL ASSESSMENT: S �'% [ C- � G�i
1 i �
- �;i, i, ��
Cletks Signature - �, � - -�' F".'. .'
Supt. of Public Works � �✓
M/P 3/76 White P.W. Canary Pinance Pink Prop. Owner Goltlenrotl Plumber
+aiN�
FSLI�
�,�
u��� �,�
�_
October 3, 1983
First Federa/
oN Uii'BR.� :l . . . .
City of Fridley, Minnesota
Fridley, Minnesota, 55432
Re:Letter of Credit
FML,Inc.
Dear Sirs,
o�Q'1, N �,y �
W �1\i
;�������`;
�K SYS��
First Federal Savings a Loan Association of Hastings is issuing this
letter of Credit of $5,000.00 to Cover completion of sod, land-
scaping and asphalt for the three four plexes to be built on lots
3 and ; of 4,6,7,8, all in Block 1 of Erco's Addition of Anoka
County, P�innesota, by FD4L,Inc.
Vert Truly Yours
, � �����
George B. Loban
�xec. Vice. President
HASTINGS �s 122EAST2NDSTREET • PHONE437-6169
APPLEVALLEY „ 14998GLAZIERAVENUE • PHONE432-6840
INVERGROVE o 6505CAHILLAVENUEEAST • PHONE455�1553
ROSEMOUNT • KEN ROSE SHOPPING CENTEF K PHONE 423�1191
S�?";'"� I�ITH US — BUILD YOUR O+A�N FUTURF �PlD ��UR f.OMF�UNifi1''� FG�� uRE
� City� of Fridlev
�
qT TME 10P OF THE TWW$
r
i �
� _ .__ COMMUNITY DEVELOPMENT DIV
r � L PROTECTIVE INSPECTION SEG.
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` i'°i � CITY HALL FRI�LEv 55632
-°-�'� ,'' 612-571-345D
,.�
BUILDING PERMIT
NUMNEP REV �niE
910-f15 70.
ioe nooaess 6534 Central Avenue N. E.
1 LEGAL LOTNO BLOCK TRAGTORADDITION
oesca 3, Pt. 4 1 Erco's Addition
2 PROPEflTVOWNER MA4 ADDAESS
F'ML, Inc. Hox 483, Hastirigs, MN 55075
7 CONTRACTOR MAILADORE55
Same
a ARGHITECTORDESIGNEl: MAILADDRESS
Michial Mularoni & Assoc. 4721 - 14th Avenue S.
5 ENGWEER MAILAODRESS
fi USE OF �UILDING
��tax�t�atx F
] G�ASSOF WORK
N DESGPIeE WORN
Construct a
9 GHANGE OF USE FROM
IX
NEW ❑ ADDITION L ALTERATION
� .. ec�
ro
�
ls. 55407
ZIP
PERMii N�—,
° 17273
REC�EIPT NO.
�U y Y 7
/n 94 1�
;'d avPHOVED BV
�
SEEATTACHEO
SMEET
PHONE
437-8007
PHONE LILENSE NO.
GHONE LICENSE NO
823-9191
PHONE LICENSE NO
❑ REPAIR ❑ MOVE ❑ REMOVE
STIPULATIONS See notations on plan. Draft stop to roof sheathing and into overhang
on upper floor. Provide attic access fran each unit. Landing must be 5 feet in
length. All corridors and stairs must be 36 inches minimum width. Water heater
must be accessible. All apartrnent entrance doors must have dead bolt locks with
no double � cylinders. Front stairway must be 1 hour construction. Doors off front
stairway and utility moms must be 20 minute rated, self-closing and have smoke
gaskets. Provide pull boxes alarm system and sensor in laundry room. Provide
outside development bond and sign landscape plan.
Betore wARa�NC >EPERATE PERMITS REQUIRED FOR
TttfPNONqg'ng �all loca� utiliiit� ��- '�TING. PLlJMBING ANQ SIGNS.
E - ELECTRfC -
��� 6AS Etc.
SE�ARATE PEFMITS AFE R E QR y.�TY1CAL PLUMBING. MEATING.
VENTILAtING OR AIR GONDITIONMG. r� �Y
THIS PERMIT BECOMES NULL AND VOIO iF WOFK OR GONSTHUCTION
AUTHOFIZED IS NOT COMMENCE� WITHIN 60 DAVS. OR IF GONSTRUCTION
OA 1NORK IS SUSPEN�E� OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME 4FTER WORK IS COMMENCED.
OGGUPANGYGROUP �OCCUPFNrpLOAD
SQ.FT
NO DwLG. UNiiS
I HEREBV GERTiFY THAT I NAVE READ AND EXAMINEO THI$ APPLICATION 4 SiALlS
AND KNOW THE SAME TO BE TRUE AND CORRECT. Al� PROVISIONS OF LAWS VALUATION
ANp ORDINANCE$ GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO
WITM WHETHER $PECIFIED HEREIN OR NOT. THE GRANTING OF A PEPMIT S1SO� ZOO
DOES NOi PRESUME TO GNE AUTHORITV TO VIOLATE OR CANCEL THE pERMITFEE
PROVISIONS OF ANV OTHER STATE O LOCAL LAW REGULALING CON-
l�ucrio oa .HE a aFOaMnNCE oF coNSraucrioN $560. 50
\ � PL4N CHECK FEE
�
����-�S'� - ��' ?� �'�' Rone .
scn>'uAeaFCnr��aac�a4oan�r„oaizeecaem- � nre� ,^;tiEti o
VA
CU FT
FSTREET PARKING
GARAGES
RTAX
S%S.�S
C CHARGE
$1,360.00
rn� FEF
$1,995.55
rHis 5 ��0��� �F.tiMr
/.\ / � � .
d
�
8uilding Address:
CITY OF FRIDLEY •
Caome ial and Industrial
Bu'ld' Permit Application
U'
� `�✓r -3 ,� � 5` �a�,�
a
Building Permit Fee Schadule:
TOTAL VALUATION
51.00 to 5500.00
i501 to $2,000
SZr001 to b25�000
525,001 to 550,000
550,001 to $100,000
5100,OD1 and up
� --�
F�S
b10.00 (Minim� Fee is 515.00 plus suzcharge)
510.00 for the iisst 5500 plus 51.50 for each
edditional $100 oz iraction thereof, to and
including $2.000
532.50 foz the first 52,000 plus 56.00 ioz ench
additional 51,000 oz fraction thereo£, ta and
includinq $25,000
5170.50 for the first 525,000 plus $4.50 for
each additional 51,000 or fraction thrseof, to
and includinq 550,00�
5283.00 for the first 550,000 plus 53.00 for
each additional $1,000 or fraction thereof, to
and including $100,000
$433v00 for the first S1D0,000 plus $2.50 for
each additional 51,000 or fzaction thereof
PLAN �CK: 65 percent of building peaeit fee
SAC Charqe: $425.00 pez SAC unit
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CITY OF FRIDLEY
6�31 UNIVERSITY AVENUE N.E., FHIDLEY, MINNESOTA 55�32
TELEPNONE 161Y1571-3150
7�SPOHAR7 CEYTIPICATS OP OCCOP1tICZ
CITS OF PAZDLSS, MI11N�507�
Dat! February 21 � 19 89
NemE of U+ner FML, Inc.
Address of Owner
Address of Building
Box 483, xas
Portion Lo De Occupled
Huilding Permit No. 17,273 _
, *IId 55075
6534 Central Avenue N.E., Fr
Entire Bui
, DW 55432
Occupancy Group Classification
This certifies that we have inspected the building at the aDove location,
�hlch is situated on Lot(s) �t 3 b Pt. of tr�t 4 � Block 1
of �co's Additior, Additlon Sn Fridley, Hinnesota
and find that the bullding does not totally comply with Lhe req�irements
of the Bullding Codes of the Clty and State of Ninnesota relating thereto.
Per¢ission Ss hereby given }'or L�e occupancy of said building, in part, in
Che manner and for the purposes herein specified aDove. This temporary
certil'icate is valid for a 5 month yeriod fro¢ Lhe above date. A
final certificate of occupancy Ss required to De Sn cocpliance wlth City
and State Bu11d1ng Codes and �ill be Sssued when the fo11ow1ng Stems have
Deen completed:
1. Canplete landscaping - Bond on File - Subject to final approval on
drainage.
2.
3•
0.
5.
6.
February 21, 1984
DATE
--- C� \�J��MV
DARRII, G. CLARIC
Chief Building Official
.
:i
CBRTIFICATE OF OCCOPAN�Y CAECIQ.IST
Date February � �g84 Buildi
Name of O�rner FniL, znc.
Address of Owner Box 483, xastings, t�] 55075
Address of Building 6534 Central Avenue N.E.
Legal Description of Property Lot 3& Pt. of 4, alock 1,
STIPULATIONS
DATE
� ��� ����� � �'�
a�� � (� w�� �
DATE APPROVED
,. � f�
2. - �3- g
3. �/
q. ,'�,
5. ZL�P�
6 .�-- (Z n Y
't . ��1-
Fire Depa
Police De
Plumbing
Electrica
City Plan
Chief Bui
Director
ADDRESS
PIN
LEGAL DESC
PERM[T TYPE
PROPERTI'TYP�
CONSTRUCTION TYPE
VALUATION
CITY OF FRIDLEY
6431 UNIV[?RSI'1'Y AVENUE NE
FR[DLEV', MN 55432
�63) �72-3604 FAX: (763) 571-1287
: 6534 CENTRAL AVE NE
: 1330242�10104
: UNAVAILABLP
: LOT BLOCK
: I3UILD[NG
: MULTf DWELL
: ROOFING
: S G,300.00
NOTG: INSTALI. PF,R MANUPAC"fURERS SPECIPIG1llONS. KLItOOF 4 PLEX.
STATE LICEI�SGD CON"iRAC"I'OR
APPLICANT
ROOF COMPANY NA INC 20172153
G364 JUNEAU LN
MAPLE GROVE. MN 5�31 I
OWNF.R
KASHAW'NY JOSF,PH
653d CENTRAL AVI: NFi
FRIDLEY. MN 554;2
AGREEMENT AND SWORN STATEMEM1T
This permit becomes null and void il'work or construction
au[horized is not commenccd witin 60 days or if construction
or work is suspended or abmidoned fbr a period of 120 days
at any time after work is commenced.
I hereby cer[ih' tlia[ I have re�d and examined this
applica[ion and kno�i� the samc [o be Vue and correct. All
provisions of laws and ordinances eoverning this type of worF
will be complied with �yl�etlier specified herein or noG The
<,ranting of a permiY�o � not presume to ;ive authority ro
violate or cancel�e ro isions of any other state or local law
reaulatin� c ru i0 or th rfomiance ofconstruction.
Ap ican _ _ Dat ' �U- °
\ ,\
f31dg Ins�-_i` ��` _` D��
PERMIT MO.: 2004-01297
D.4TE ISSUED: 08/10/2004
[3UILUING PERMIT FEE
FIRE SURCHARGE
STATE SURCHARGE, Vf�LUF
LICk:NSE SURCHARGE
f0I'�I,
PAID WI'fH CHECK n 7121
SEPARATG PERMITS REQ2JIRED �OR WOFfK OTHER THAN DESCRIBGD ABOV6.
I 3925
6.30
3.15
5.00
153.70
CITY OF FRIDLEY �-� �`���
6431 University Ave NE R-3/COMMERCIAL/INDUSTRIAL/PUBLIGINSTITUTIONAL
Fridley, MN 55432 BLTILDING PERMIT APPLICATION
(763) 572-3604 FAX (763) 571-1287
CONSTRUCTION ADDRES$ C `� � `/ C� �� �' •� � %�t'� 'v%= Zoni ng
1/1/2004
Legal
Owner & Address ���e✓ �°M�� iC Tel# (45� ) 5'�'� �`�%
�
CONTRACTOR & ADDRESS � Q°�r �o. N.q ��.r� 7°/3 T���= �J�. Tel# (7�S ) 53U �%�f5�
�✓%F!/i7ca ��•/•✓
Architect P,eg.# Engineer Reg.#
TYPE OF WORK [] New
DFC. P.REA: Length
WHSE AREA: Length
OTHER AREA: Length
BUILDING CONSTRUCTION
[] Addition [] Alteration -Describe ��ii � ' O�a � 7
Width
Width
Width
Height
Height
Height
APPLICANT � "'-/ %��'f Tel #PiJ Zz6-�7zG
VALUATION
Sq. Ft. x 8 Cost/Sq. Ft. = Valuation
Sq. Ft. x S Cost/Sq. Ft. = Valuation
Sq. Ft. x S Cost/Sq. Ft. = Valuation
Sq
Sq
Sq
Ft.
ft.
Ft.
Date �- /O ��`-�
s >
$ � _ $ OG
$ ) TOTAL VAWE
Building Use Construction Type Occupancy Group
Air Conditioning [)Yes C]No Fire Protection Provided C]Yes []No
Performance Bond Amount 8 See Reverse for Schedule Received C]Yes C]No
PERMIT FEES
Permit Fee
Plan Check
Fire Surcharge
State Surcharge
>� ,;�"
8
S
�.
g , j /.�,
SAC Charge S
Erosion Contral 8 �-C Y
Park Fee S
Spec. Assessments S
Curb Cut Escrow S
TOTAL 8 /� � ��n
See Fee Schedule on Reverse Side
65% of Building Permit Fee
.001 x Permit Valuation (1/lOth %)
8.50/81,000 Valuation (See Sched. for > 81 Million)
81350 per SAC Unit (Plans to MWCC for determination)
$450.00 Conservation Plan Review
Fee Determined By Engineering
Agreement Necessary [] Not Necessary C]
feet x /foot
ATTACH STIPULATIONS
$1 to $500
$501 to $2,000
$2,001 [o $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,400
$500,001 to $1,000,000
$1,000,001 and up
BUILDING PERMIT FEE SCHEDULE
$23.50 (Minirnum Fee is $23.50 plus surcharge)
$23.50 for lst $500 plus �3.05 for each addn'1 $100 or
fraction, to and including $2,000
$69.25 for lst $2,000 plus $14.00 for each addn'1 $1,000 or
fraction, to and including $25,000
$391.25 for ls[ $25,000 plus $10.10 for each addn'I $1,000 or
fraction, to and including $50,000
$643.75 for lst $50,000 plus $7.00 for each addn'1 $1,000 or
fraction,to and including $100,000
$993.75 for lst $100,000 plus $5.60 for each addn'1 $1,000 or
fraction, to and including $500,000
$3,233.75 for the lst $500,000 plus $4.75 for each addn'1
$1,000 or fraction,to and including $1,000,000
$5,608.75 for the lst $1,000,000 plus $3.15 for each addn'l
$1,000 or fraction
PREPAID PLA.'�1 CHECK FEE SCHEDULE
Per Minnesota Building Code - 65% of building pernut fee.
PERFOR�fANCE BOND POLICIES
When a building permit is issued for a commercial, industrial or a multiple dwelling
residential projec[ which requires ou[side improvements, a Performance Bond or a Letter of
Credit shall be submitted to the City. The bond will cover all outside improvements, including
but no[ limited to landscapin2, irrigation, curbing, blacktoppin�, screening fences, lighting,
water & sanitary sewer services, and storm drainage systems.
Calculation of bond amounts will be de[ermined by the building pemu[ values. The
bond amount will be 3% of the building permit value up to a 2 million dollar project or a
$60,000 bond. Actual amounu will be rounded to the nearest $1Q0. The Ciry reserves the
right to require greater or lesser bond amounts based on unusual circumstances. Projects with
no outside unprovements, generally will not require a bond.
Bonds must remain open until the project is fully completed. Reproducible "as-built"
drawings of all ex[erior underground utili[ies must be submitted to the City Engineering Dept
before the project is considered complete and the bond released. All bonds will be held over
one winrer and through the next growing season to insure the survival of all landscape
installations. The City will then inspect these properties in Aub st of the year following the
initial plan[ing. Bonds may then be released in October of chat year if all improvements are
satisfactorily completed.
ADDRESS
P1�
LEGAL DESC
Pf RM IT TYP�
PROPERTY TY'PI?
CONSTRUCTION TYPE
CITY OF FRIDLEY
G431 UNIVF,RSITY AVENUE NE
FRIDLEY, MN 55432
J/L-SbU4 NAX:
: 6i34 CF,N'IRAI„AVE NE
. 1330242-00104
: UNAVAILABLE
: LOT 0 L31,OCK 0
: BUILDING
: MUL:I'I UWFiLL
: DGCK
J/1-1L257
PERMIT NO.: 2004-01590
DATE ISSUF,D: 09/14/2004
VALUATION : $ 818.00
NOTE: SEE NO"I�ATIONS ON PLAN.
CALL GOPHCR STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. REBUILD 4' X 8' DECKS.
APPWCANT
ROGER FEMRITE
4773 MANITOU RD
MINNEAPOLIS. MN j5331-
OWNER
ROGER FEMRII F
4773 MANITOU RD
MINNEAPOLIS, MN 55331-
.4GREEMfNT AND S�1'ORN STATEVIF.NT
This permit becomcs null �nd void if work or construction
authorizzd is not commenced witin 60 davs or if cons[ruction
or work is suspendcd or abandoned for a period of 120 days
at am time after wnrk is commenced.
1 hereby certify �hat 1 have read and examined this
application and knuw the same to be u�uc and correcL All
provisions of laws and ordinances ;o�-ernin, this type of worb
will be complied with whether specified herein or noL 7�he
granting of a permit does not presume to eive authorirv to
violate or canccl the provisions of any oth€r statc or local law
regulating eonstrucUnn or the performance of construction.
61dg Ins,p.�_�
I�UILDING PERMIT FEE
PLAN CHECK FEE
1=1RE SURCHARGE
S'I'n'I'G SURCHARGE, VALUE
TOTAL
S�PARATE PERMITS REQUIRED FOR �VORK O'iHER THAN DESCRIBED ABOVE.
35.70
23.21
0.82
0.50
60.23
NEW
ADDN
ALTER
�)
�]
�]
Construction Address:
CITY OF FRIDLEY Effective 411I2004
6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMITAPPUCATION � �
,(?�� �� :5� / L�
Legal Description: _
Owner Name 8 Address:
Contractor:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
re�. # Go /� - %a?O-G�/5'Z
MN LICENSE
Tel. #
A2tach to this application, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length
Length �
L � �
Width Height Sq. Ft.
Width � HgUGround � Sq. Ft. �_ `�
9, �j �' � �=�� ,. �� `r
���.
C� /
Construction Type: L�✓ Estimated Cost: $ o%�� � G�����iJ
Driveway Curb Cut Width Needed: _Ft. + 6 Ft =_Ft x$ _�
DATE: I F ��� APPLICANT: �d�.� /7%? /� Tel. #%�a ^ 7'O 1�Q5 Z-
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 ii using credit card and we will cail
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ )� , ��
$ �t 3 . � I
$ � y?��
$ 5C ;
$
$
$
$
$
$
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 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:
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 bu�lding 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
$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 fust $2,000 plus $14.00 for each additiona] $1,000
or fraction [hereof, 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 fust $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
$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 the annually detcrmined
rate
Pemrits 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 lhe construction site.
VERIF'ICATION 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 Onlv
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CER71FiCATE OF tNSURaruCE
This cert�fies tr,at �'� STASE FARM FiRE AN�� GPS�.!AI TY CONPAkv 5fnomingtor. i inois
[� Si;,7E FARU GENFRAI. iWS1.RANCE LCiMPANI' B!oommgton :limo�s
[ S;�Arc FARM �IF.£ An� �PSUALTV CO\�pqNY Starbcrou3h, On;aric
[', STATE F4FM F�.pftIDA MSGRANI,E G;;M"ANY ✓�/inter Haven. Flo•ida
�� E;�rqTE FqRM LLOVUS �aNaS. �rrxas
n�5ures lhe teilo+nng po��cyhc�lAei f0! IhP. euverzges ��rdiCaibd 9elow
PaLCY^�C`I�e.! ApGGY. � L�.itF. FF1dF 1"F
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4ddresS:i�+f,lilyh(11Ar,i a...�' °IJ:-Lra.' F.c_k• ...�CW.:A �.Ti, >S:d ._.,71 �
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_OCB[IJ�otU�a'aLCnS <ii4 !'F.H'71V. 4�G '.- F1�"'f"'. `;1: 5c4:<
Descnptioao'ope�at;on> kEr.�ta. i�•::r -. .- -- -- � -- --_.
�T�9 p�hcies lis:cd �r� Gw nec•i b�n Saued to the poncyr� ider foi th:e poLCy prnods 5how�; The insw-ancr Aes .npetl In these poliCies is
s,�o�ed to ail the tBirns eed.:.�crs, and condilicns o' tno;e pehcins The limits ef liability shcwn may ��avr been red�ced cy any pa�a
C131(YMS
r POLIGY Y£RIOD
_ POLiCY NUMBER ' I TYPE Of INSURANCE I Etlectrve Drte �� F�pr�rn Date_
� �_ — . _._ I C�mprenenslv¢ � � ' � � i' -�'��`
� d.siness Labit¢y
. _. . _... .... .
.....__..._..., . . .... . .. .
rn�s .reu�ancz mo��aes �[; Products - Compieted Cperehc ❑^
� � Contractuai Uabihry
�� � i:n�er9rc�na Nazartl CovcraGe
�'� ?e�sonal Injury
U Advert�sing In;ury
. `] ��.piosion Hazartl Co�e•age
� =� ;�qilapse NaSard Coverage
7 �, 1n�� _ __;.^[�:`.
EXG=55 LIABILiiv
U '�JmGrala
❑ Olher
�.VCrkers' Compensation
and EmVloyers ��ab+lity
POLICY NUMBER I TYPE OF INSURANCE
LIMRS OF LIAB�LITY
�at beginnin� of policy per�od)
E3pC�i�_Y INJJRV A�L
FR,:,P[aTY DAMAGE
Each Oce�uen:�.e
Ge�erni Ag��egate
Prctl�Cts - Cump eted
Cperatwr�.s Prgragate
5 . . . o.
$ _P'. GC
E . ,�. , .,
POLICY PkRIOD RuDIL�� INJ�.IRV AND P40PERTV UAMAGE
EMective Date � Ezpiration DAIa (Comh�nrd Smgle Limd�
. Eact� OccurrencF S
. , Auareqate $
Part 1 STATU7nR�
c'art 2 BUDiL� INJI�RY
i Each AcciAent S
' � DiSCBSB-EadiCmployee$
� D�sease - Poik� L�rnit Z
--�--'----- � �- ----..__.
POUCY PERIOD � LIMITS CF LlABIUTY
ETfettive Date ExpiraGon Oulr (at beyinn�ng of poiicy perictl)
- � —r---- . . _ ... -------
--� -__... .__ -- -- --- - -- . ..---- ' -----� - ----
INE CERIIFICAiE OF fNSUfiANCE IS NOT A t:ONTRACi pF INSURANL'E AND NEITHER AFFiRMA7lVEl.Y NOR NEGATIVELY
AMENOS, EX7EN[Yd Ok ALTERS THf COVERAGE APPROVED 6V aNY PQUCY UtSCRI�ED HEREiN
If any of Me Jescr�oeC pohcies arp �ancele<1 bef0�e
rts erpiraLOn date. StTte Fatm .v:ll try tc mai; e
wnttan not�.ce t0 t4e a�ttih: ntP. I+elder
Name and Fddress of Cer1�fiC8lN HOlde� AayS befofe eancellatwn if buwavef. we fail tv m8i�
such not+ce no oohgaUOn or habllity will be imposed
a�:: �� �;� �r� r-+;.r r on 5tytr Fann or'�ty aUentx or ieprasentatrves
_'='�r.- MFr�, �.+,r:r�,:
GI'..`.: 1: ' _ : l '� _ .
- ��7��'3'`-y� ----
SgnaNre of A1RIqr�zEd RepreEentalwe
c...
.___._- _ - __ ..
' itle Date
, Ay¢nfe �a1e Stamp- _ . . . _. . . _ -_-_'
Arp CoOe
eSe.Yb1 w 9'.1-�2�1[O) Pn.xrd ��� p$ a