AF - 36355City of Fridley, Min.n..
BIJILDING PEI�.MIT N� 59�r2
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Owner: Builder
� `°�d�� " Address
LOCATIO D G
No. ��---�� Sfreet --��-�"�� SS�..t'� Pari of Lot ��.� ...._.
LOt ��-- 81� � :—_ Adc3ition or Sub-Divisio .-�����
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Corner Lot , ._.�.. Inside Lot Setback Sid�yard �
Sewer IIevation �__.__ .._. Foundation IIevai3on ._.._
DESCRIPTION OP BUILDIIdG
To Used ps• �
Front ���� Depth ,�,� Height � �!' _ Sq. F't. ����Cu. Ft ���,�l�,�
� t- Depth __.. �• Hei t�.�� Sq. Ft, Cu. Ft
Type of Conatructio �. Es� �ost � �''""�o be Com�leted .
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In consideration of the issuance io me oi a permit to construct tlie building described above, I agree to do
the proposed work in accordance vvitli the descripi3on above set fortdY and in compliance with all provisions of
ordinances oP the dty of Fr3diey.
�
In consideratlon of the payment of a fee of $��'"v , permit fs hereby gra.nted to
to construct the building or adclition as described above. This permit is gra.nted upon
the express condition that the person to whom it is gra.nted and his agents, employees and worl�en, in alI work
�one fn, around and upon said building, or any part thereof, shall c�nform in all respecis to the ordinances of
Fridley, Minnesota regarding location, construction, altera.tion, maintena,nce, repair and moving of buildings
��e d'ty ]imits and this permit may be revoked et any time u�n violati�f any of the provisions of seid
Buiiding Inspector
NOTIC� - �
Th(s permit does not eover the construcHon; ieslaliatien fo� wieinB. R����e. B� beatYn9, aewe� or wafer. Be wro fo as
tb. Buildleg Inspeetor fo� separate permiM for t6e� hems,
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OHmer's
Addres
APPLICI�iTIO�T FOi� SU27�D�NG PERI►�IT
� >C3TY OF �tIDLEX, MiT�tESaI'A
Name - Builder
LdCATION OF SU�ILDING '
No, �,�Stree� % Paxt ofc Lot
Lot.__ �� Block�� Addition or Sumdiv�is�.on `li
��,�' P..P
Corn�er Lot inside Lot���etback Side-'Yard _
5E6�lE�i ELEVATI-ON FOUNDATSOLlT ELEVATiOLiT
Applicant a�t�tach to this �orm Certi�icate of Survey o� Lot and
�ropose� building ].oca�ion.
DE�C`RIPTIOIV OF BUILDIN� ;
To be us�d aso '
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Front__„�,_Depth � °FIeight � �
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Sq . Ft .�. � ��`Cu . F't .�,� �D �
Front_�_____Dep•ch Fieight
Sq . l�� . - - Cu e Ft.
> � ....._�.�
�
lype .of Construcfcion ; � Est�.mat�d Cos�
10 be Completed
,�_
The undersignecl here�y makes appiication gor a permit �or fihe wo�ck
here�.n speci��ted, agree.�.ng .to do a11 wo�k in strict accor�ance with
tlne C�.ty of Frid�ey Ord�.nances and ru].ing o� the Depar�cment of Build-
ings,.and hereby declaYes that alZ the facts and re�resenta�ions
s�tated'in thas ap�licat3on are true and corr .
DATE----- � �� ��� , SSGNA3'URE ► .
tSchedule of Fee Costs can be faund on the Rev�rse��ide).
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BU3LD�NG PERI+�IT � ��D�
Sec�3on 2. The Tnspeator o� Bu�.lcii�gs ehall, �e�o�e issuing any
per�ni�t �or the e�ec4ion oi any buildtnc� or structure, or for any
addition to any ox�s��ng buiiding or `struc�ure, or for any alterations
or repa�rs to any oxistin�j build�.ng or s�rucicure, upon� appl3.catian
�harefor, requise �ho pay�nent by fihe applicant fo�c such permit of
fees to the amount herej.n below set �orth and in �he ma�rtar herein
pxov�.ded to wita
2.1. For any suc� p��nit �o�c the erection o� any fire-proo� build�.ng.
--- ----�i�r - tii�n=`a�9ra�`a9z� � - fiaagc�o�s��� -�a� - - o�_ g��a�ri e1��a��, or -��or �ie -
�
erec��.on o� atYy �ire-p�ao� addition, �ar similar occupancy, to any
existcing building shall be at the rate Q� $1.4Q for eacl� ono- tliousarrd
cu��Lc �eet, or fraction thereof, in such cubical contents.
2�. ,2_. For any euch p�rm�t iEor the erect3on o�E any fire-proo� garage,
v�a�cehouse, �ac�oacy or grain e].evator, or iEor the erection or any �ire-
proo� addition, �or si�ni.lax occupancy, �to any existing bu��.ding shall
�e at the rato o� $1.25 �or oach one thousand cub3c: �'eet, class�.�ied
as "�ireprooi" by �ee�ion 502 ofc th� Minneapolis Suild�.ng Code.
�OUSES �
�.� _
2.3. For any such permi� for the e�cec�ion of any r�on-i�i�eproof build-
�.r�g oth�r than a garac�e, warehouse, faciory or gra� elevator, or any
aon-r3seproo�E addi�c�.on, for similar occupancy, to any existing building.
Permit $1.00 for each one thousand cubic teet.
GA'tt�,GES '
�
- - - 2��� __ FQ� any_s�i�e�ri►i.�__�CO�_:the_-�uc�c�:L�sr�-�-�a� -��-fire�x1oof --- _
� -�garage, warehouse, Lactory or gra�.t� e�.eva�or, or for the erectian of
any no�-�ireproo� add�.�ionr �car aimilar occupancy, to any_ exist�i�g ,
build#nc� or �or each such building-.:or addition. Ninety Cen�s for �ach
oae �noueand cubic ieet or fractiqn �thereof, in the cubical contents
thereo� wi�h a miniznuna o� $9�v00.
Fo� the purpoee o� co�q,outing fees for �uilding permita the cubical con-
tents of any bu�.ic�irig or addition �o a unifo�crn height throughou� by
multiplying the ground ascea cov�+red ;crom a point six (6) inche�s beivw
�he flaor line o� �the basement or cellar to the average height of the
upper surface or �co �h� average hei.gh� of the roo� aurface of the mairi
g.able o� a p�tched roo�.
2.5. For repairs o� alte�atiorls to an r�xis�tirig $tructure, the ree
shall be at �he ra�e o� $3.00 pe�r each_Five Hundred Dolla�s .($500.00)
or �-�cactio�► �Y►ereor in �he coat o� all. proposed wark. �'
2.6e in no case shall the fee chargecl
� ' S �ioas 2 be le�s �p $4.00.
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for any permit as s�t fo�th in
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PROT@�TIVB INBPBGTION BEC.
s'"°'1� i• OITM HA�L FRICLEY 89438 Nut�BeR —
��"'"°�e� •a 61�•680•3480 —
810-F16
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,�� A�@���� 6571 Channel Road N. E.
�`�q�� LqT NA, - BLO�K ---- - TRACT iDR ADDITION
A�Q�R� 11 1 Erco`s lst
-2- HROPE�iTY OWN�R - -- - --_ _ 1QIA1G A�LlF1�88 - — --- � _
S.P.G.A. Assoc. 9Q9 F& M Builc
�._ �ONTRACTOR - _ MAILADQRESB - -- -_
Walker Roofin 2008 - 13th Av
4 AR�HIT�GT OH p�t91QNER MAIL ApCRE88
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° 14608
IE PT NO,
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8EE ATTACHE�
SHEET
7 OLA&8 0F WORK - - - - - - -
Q NkW Q ADDITION X ALTERATION ❑ REPAIR C] MOVB C7 R�MOV�
B t?�BRRIS�V110RK - - - _ _ - -- - - - _ __ - - -
Reroof apartlnent buildina
- _
_ _- ----- --- __ _ -_ __ .__. _.
�_ P�lA��9��' d�� �o� : -- -- -- - - - _ _ - _ _ �ia -- -
-- __ — - — _ --- - —
��'������N� Existi,ng roof to be removed. Install ridged galvanized valleys.
� �A�AT� P�HM�T& A�� ���yIP�� �pF �L�GTPIGA�, R�NMBIN�q� b�k1TIN;�,
v Nr�bnrrN� �� AI� �19NPIfI�NiN�,
�NM� �_MI� � ��M��'N IuLE �NP �!�pI�A I�' �lAPl� �P s�aN�f�u�c�I�N
��YhI�p�Z�� I� ���F �RMh►�N�cEp wiibiN �� AAYs� �qF� IF �GCIyBTRI]�'FION
Qk�'��PK�I� �U�� N��R �R Al�a�lP�N�P @�QR A R€Fl�1a �F 1�o RA1'� AT
ANY �'I�� A�'T��3 ���K !� IGQMMEN��p.
��
Aspha.lt
NTRi�- - - - Si�: --
r.--P?NF� f1i�Tl7s
BT�!�l.$
�A,�.��N __ __���_ _ ____�
$2,500
Pr7ItT FEE . _ _ _ _
$15.00
_ _ �II:FT: -- -----
QFFBTPEE7 BAPKfNCi-- --- --
��AP�1Q�8
SURi°aX" -- - �___ _ _�a _ -
$1.26
SACCHARqE— — ---
�oTatF�� ---- ------
$16.26
: A�'F�TS-rs`��r��°-°-��
���R��1�
.
crTY or- r-�zzv�cY
' APPLIC/1TI011 FOR RL-:SI1)(:NTIl1L BUILDI�IG PE(tf�1ITS ,
' (iV�w, %iLTL"R/1T10PdS, �DUITIO(J5, OR RCP�I(�S)
ow�a�R: � � (��� S�S C ' l3UILll�12: � ,� ,� �' ��=�; .
Address : _ ./ � �� � � �t - �, Address : � (7 � cF ;�j ��. ��-�' ��, .
�� _ ---�—�
Tel . Iso . : �✓�/ ,/,� �J
No. : 5tr eet : .
� /.. l
LOT: _� %� }3IACY.: ADDITION: _,p...a i°C.'� C' � ST
CORN�R LOT: IT3STDE LOT: SLTBIICY.: SID�YI�RDS:
Ap�lica'r,t attach 'L-o this form �ao Certiiicates of Survey o£ Lot and proposed
bu3.lding locaL-ian drawn on these Certificates. .
DESCRI PTI OId OF BUI LDI I�G
To l3e Used �1s: �— •
_�� �c�c�� �� OFront: Depth: • - Hei ht:
9
Square Feet: Cubic Feet:
I�ront: Depth: � Height:
� Square Feet: Cubic-Feet:
�
Type af Construction: f(���,,,�,j�• Estimated Cost: $ .�
xb Be Campleted: _���/�� ���� �(� Alt. A Alt. B
Proposed Driveway Widtiz If 21ew Opening Is Desired $ $ •
(S�� R�VERSE SIDE OF SFiEET)
The unaersigned hereby makes applica�ion for a permit for the work herein
specified, agreeing to do all c.ork in stzict accardance �aith the City of
Fxi.dle�� Ordinances and ruliilgs of the Denartment oi Buildings, and hereby
declares L•hat all tlZC facts and re��resen�ations stated in i:his application
are true and correct. See reverse side far acldition�l inionnation.
J �" �/�j
DATE: � c� � STGNATUP.E: ,� � �,
Stipulations:
l��
1��-4°
��.
��
�
BUILDI(JG PERt�1IT FEt 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 fee�.
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
�11 � : l �' : �l
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 surf ace 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.
VERIFICATIO� OF FOUNDATION
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 per.mit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
'° �
SUBJECT n
c�ty of Fridley r �
AT THE TOP OF THE TWINS g U I L D I N G P E R 6�� r� �
r IYII I
� �
� �
COMMUNITY DEVELOPMENT DIV.
� iV������� •
r � � PROTECTIVE INSPECTION SEC. ���
� ,
i
l-___ A �����;,j CITY HALL FRIDLE� SS432 NUMBER REV DATE PAGE OF APPqOVED BV
L J� 612-571-3450 910-F15 2/20/96 / /
JOB ADDRESS
6571 Channel Road �l
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oesca. 11 1 Erco's lst Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS IIP PHONE
S& R M t Co 1304 Universit Ave NE 331-6679
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Rite Wa Wate o f
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
A artme
7 CIASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Int rior
9 CHANGE OF USE FROM TO
STIPULATIONS
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 SQ. 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. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO 8E 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�680 �i.64
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE pERM1T FEE SAC CHARGE
PqOVISIONS OF Y OTHER STATE L CAL LAW REGULATING CON-
R CTION E RFOR NC F NSTRU r,. $54. �� Fire S�.' � 1. 68
�� `^� PLAN CNECK FEE TOTAL FEE
$56.32
IGNATUREOFCON'RACTOAORAUTHOA�ZEDAGENT IOATEI WHEN PFiOPE Y VALIDATED THIS IS YOUR PERMIT
S�GNATURE OF OWNER UF OWNEA BUILDEHi IDATEi � ` ����
DG iNSP qp7E
NEW [ ]
ADDN [ )
ALTER []
... . .. .... ...... .. . .......,.,. ..... :.,.;.
............. ..... ...:.:, ,:.<.:. _
. . . . . . . . .......<.,�:.;,,,�;>;,;�a;•,->.,,;;�;»�;h�.•;>;>;�:::�r,;::,;:;:;:;:;:;:,:t:<;;;;:;;s;:� .. . ..�.
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstrucdonAddress: % S'�7 I (�.
Legal Description:
�
Effective 8/1/95
.��/�
Owner Name & Address: _ : �6 , ���'`` �"�►� , ciu. ��: �- —
� , � Y�'i��V1ri o �-c� . �t��:� o� r� ��sti► �� Tel. # 3 � � - 1�� � �
Contractor: � l`� _ 1� � _ 2 ��,� � � �- � MN LICENSE #
Address: � �� � L i �-�-�_ � �� � I �� � L � I�t�� , %1�1 ��`-� [ � I Tel. # �/�, - C� ��L� �`�
Attach to this application, a Certificate of Sun►ey of the
lot, with the proposai construction dra.wn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
�II$'d� Width Height
L�II$th Width Height
Length Width Hg#/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks
� w�-rza�.-�-� r�� ��;
�8 Of C011Sh11CilOII: —Iurr.-a2�e� � �-�vi- '7' c�f�� -n �� sus; ci�� �� COSt: � � ��'�9 .
Approx. Completion Date: � - � � � �y �
(Cost on Back)
Driveway Curb Cut Widtb N�ded: Ft. + 6 Ft = Ft x$ _$
DATE: � - 1 �t - i� �_ APPI,ICANT: `"lC� �( �;"C�� �,C-1 c�C. `� Tel. �# ` - � ;�
Per�mit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Fscrow
Erosion Contirol
Park Fee
�wer Main Charge
TOTAL
STIPULATIONS:
� � �/. UC)
$ /• �o�
$ �`�
$ °,`�'
$ �x�7��r�-
$
$
$
$
$ ��,.��
�ITY USE ONLY`
Fee Schalule on Reverse Side
.(�1 of Permit Valuation (1/10th%)
$.50/$1,�00 Valuation
$850 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Atbove
$450.00 Conservation Plan Review
Fee Determiaed by Engincering
Agreement N�essary [ ] Not Na�;ssary [ ]
c � �- -
�UILDING PERMIT FEE SCHEDULE
.,, , .,,,_...,,»,,,,,,;,;,;,;,;, ,;;;;;�;�:�,:,...,..,:. ..:.�
The Chief Building Official shall, before issuing permits for the ere,ction of any building or structur�, or for
arry addition to any existing building or structure, or for any alteration or repair to any e�sting building or
siructure, upon application therefore, require the payment b� the applicant for such permit of fee.s to the amonnt
herein below set forth and in the manner herein provided to-wit: �
TOTAL VALUE
$1 to $5�
$501 to $2,000
$2,�1 to $25,�0
$25,�1 to $50,0�
$50,001 to $1�,Q00
$100,001 to $500,(�IO
$500,001 to $1,000,�
$1,0�,�1 and up
FEES
$21 {Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $1� or
fraction thereof, to and including $2,t�00
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fiactio4 ther�f, to and including $25,�0
$349.75 for first $25,OOQ plus $9.00 for each additionat $1,t100
or fraction thereof, to and including $50,000 �
$574.75 far first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$$87.25 for first $100,000 plus $5.� for each ad.ditionai
$1,0� or fraction thereof, to and including $5�,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,0� or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,�0 plus $2.75 for each additionai
$1,�0 or fraction thereof
DRIVEWAY DEPRESSION ESCRUW
(Concrete Curb Streeis Only)
Alternate "A" : Removal and reglacement of cu� and gutter only - Driveway width plus b feet times $13.�.
Alteinate "B" : Remoeal and replacement of curb and gutter and install a 3 foot wide
a�proach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 2A� hours from the time of application to allow for proper
review of the proposed structure and of the canstruction site.
A Certificate of Survey of the lot, showiag the l�ation of the foundation once it has it has been constructed
will be required before proceeding with the framing.
City of Fridley ��+��� �
AT THE TOP OF TME 7WINS � � I L D 1 N G P E R M I T
r
� �
; �y _ COMMUNITY DEVELOPMENT DIV.
r j � PFiOTECTIVE INSPECTION SEC.
l--�.�� �'��� �'� CITY NALI FRIOLE� SS1�2 NUM�@P
L 612-571-3450
s�aF�s
lOB ADDRESS
6571 Channel Road NE
1 LEGAL �OT N0. BLOCK Ti;ACT OR ADOITION
REv
DESCR. 11 1 Erco's lst Addition
t PROPERTY OWNER MA4L ApDRES$
S & R Management
3 CON7RACTOR MAIL ADDRESS
4 ARCHITECT OR [
5 ENGINEER
8 USE OF BUILOINI
11 Unit Ax
7 CLASS OF WORK
8 DESCRIBE WORK
Reroof Bui
14510 45 St NE, Rc
ER MAIL AODFiESS
MAII ADDRESS
tment
❑ NEW
9 CHAN(iE OF USE FROM
DATE
3/31/00
ZIP
PAGE Oi
/ /
PHONE
97-3
PMONE
PHONE
P�AMI'°'"'�
30780
RECEi�T NO.
/��
��naOVEO Br
SEE ATTaCMED
SMEET
LICENSE NO
LICENSE NO.
LICENSE NO
� ADDITION � ALTERATION ❑ REPAIR O MOVE O REMOVE
X
; Tear-off
TO
STIPULATIONS
Underlayment must comply with the State Building Code. Install per manufacturer's
specifications.
SEPARATE PERMITS ARE HEOUIRED FOR ELECTRICAL, PLUMBING, MEATING, � rre or cvnsr.
VENTILATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION IONING
AUTHORIZED IS NOT COMMENCEO VM!ITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOEO OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AF7ER WORK IS COMMENCED. NO. DWLG. UNITS
I HEREBY CEF;TIfY THAT I HAVE FEAD AND EXAMINED THIS APPLICATION
AND KNOW TME SAME TO 8E TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUA110N
ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMP�IE�
WITH WHETHEq SPEC�FIED HEREIN Ofi NOT. TME GRANTING OF A PERMIT 3 499
DOES NOT PRE$UME TO GIVE AUTHORITY TO VIOLATE Ofi CANCEL THE pEFiMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON•
STRUCTION Op THE PERFORMANCE Of CONSTRUCTION $97�Zrj
/� PLAN CNECK F
'� .3/�� � .
S� TUAE O� CON'AACTOp OA AUTMOA�ZED AGENT - I ATE� N P �
S�GN4TUAE O� OWNEA ��� OWNEp BWLOHA� IDATEi �, ,. g�p iq5o �
FT
STALIS
r
iROUP OCCUPAN
CU fT
OfFSTREET PARKING
IGAFAGES
SURTAX
$1.75
SAC CMARGE
Fire SC $3.50
TOT FEE
102.50
LOAO
Prepaid Plan Check $
Estimated Cost $
Receipt #
CITY OF FRIDLEY
R-3, COI�IlKERCIAL & INDIISTRIAL
BIIILDING PLRMIT APPLICATION
Construction �,ddress _ ,S �l ���� ��,�
Legal _
Effective 1/1/2000
(612)572-3604
�� 7�
Zoning
Owner & Address S'4'' � f��„��y����; Tel# ( )
�
CONTR.ACTOR & �DxESS % t� � r � , Tel# ( 1a� �{9'? �9�
_ �G��_� _ �i�/� . ` n l' t � �' C�'S -2 �cf
Architect
TYPE OF ORK [] New
�i''�Ci�'
Reg.# Engineer_
Reg.#
BIIILDING CONSTRUCTION
Addition [] Alteration -Describe � �'��
�.. �� � „ ..�.-
OFC. AREA: Length Width Height Sq. Ft.
WHSE AREA: Length Width Height Sq. Ft.
OTHER AREA: Length Width Height Sq. Ft.
APPLICANT ��� r,�,,� .. Tei #�%2��"�'7�3� D� aate -� � 2c��' �
VALIIATION ��� �
Sq. Ft. x$ Cost/Sq. Ft. = Valuation $ )
Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) _ $ . �
Sq. Ft. x$ Cost/Sq. Ft. = Valuation $ ) TOTAL VALUE
Building Use Construction Type Occupancy Group
Air Conditioning [] Yes [] No Fire Protection Provided [] Yes [] No
Performance Bond Amount $ See Reverse for Schedule Received []Yes []No
PERMIT FEES
Permit Fee $ C 7, 1� See Fee Schedule on Reverse Side
Plan Check $ .� In Excess of Prepaid Amount - See Reverse Side
Fire Surcharge $ ,3 ,j !•� .001 x Permit Valuation (1/lOth �)
State Surcharge $ �s %� $.50/$1,000 Valuation (See Sched, for >$1 Million)
SAC Charge $ $1100 per SAC Unit (Plans to MWCC for determination)
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ Fee Determined By Engineering
Spec. Assessments $ Agreement Necessary [] Not Necessary []
Driveway Escrow $ feet x $15.50/foot
TOTAL � � `
��e- �� ��
�37,.�0
_��
ATTACH STIPULATIONS
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,(300
$50,001 to $100,000
$100,001 to $500,000
$5�,�1 to $1,000,000
$1,0�,001 and up
BUILDING PERMIT FEE SCHEDULE
$23.50 (Minimum 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,Q00 or
fraction, ta and including $25,000
$391.25 for lst $25,000 plus $10.10 for each addn'1$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 1 st $100, 000 plus $5.60 for each addn' 1$1,�0 or
fraction, to and including $5(�,(�0
$3,233.75 for the lst $5�,(�0 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'1
$1,(�0 or fraction
PREPAID PLAN CHECB FEE SCHEDULE
Per Minnesota Building Code - 65 % of building permit fee.
PERFORMANCE BOND POLICIES
When a building permit is issued for a commercial, industrial or a multiple dwelling
residential project which requires outside improvements, a Performance Bond or a I.etter of
Credit shall be submitted to the City. The bond will cover all outside improvements, including
but not limited. to landscaping, irrigation, curbing, blacktopping, screening fences, lighting,
water & sanitary sewer services, and storm drainage systems.
Calcularion of bond amounts will be determined by the building permit values. The
bond amount will be 3% of the building permit value up to a 2 million dollar project or a
$60,0� bond. Actual amounts will be rounded to the nearest $100. The City reserves the right
to require greater or lesser bond amounts based on unusual circumstances. Projects with no
outside improvements, generally will not require a bond.
Bonds must remain open until the project is fully completed. Repr�iucible "as-built"
drawings of all exterior underground utilities must be submitted to the City Engineering Dept
before the project is considered complete and the bond released. All bonds will be held over
one winter and through the next growing season to insure the survival of all landscape
installations. The Ciry will then inspect these properties in August of the year following the
initial planting. Bonds may then be released in October of that year if all improvements are
satisfactorily completed.
;-,..
Sue�ECr
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T(
i •
� �
; �L _���� COMMUNITY DEvELOPMENT DIV.
r j � PROTECTIVE INSPECTiON SEC
l--_.�� �"�� ��� CITY HALL FRIOLEV SSIJ2 NUMBER NEV DATE nAGE O�
L 763-571-3450 910-F15 6/13/03 / /
108 ADDHESS 6551 & 6571 Channel Road NE
1 IEGAL �OT NO. BLOCK TRACT Ofi ADDITION
oescR. 9& 11 1 Erco's lst Addition
2 PROPENTV OWNEfi MAIL ADDpES$
3 CONTRACTOfi MAII ADORESS
Dorglass Inc 6008 Cu�iigan Way, Minnetoak�, MN 55345
4 AiiCHITECT OR DESIGNER MAIL ADORESS
5 ENGINEER MAII ADDRESS
21P
ZIP
33610=
T NO.
��povEO er
SEE ATTACNED
SHEET
PHONE LICENSE NO
952-253-0097
PMONE LICENSE NO.
PMONE LICENSE NO
8 USE OF BUILDING
Apartment Buildings (Two 11 Units)
7 CLASS OF WORK
� NEW ❑ ADDITION � ALTERATION � REPAIFi p MOVE O FiEMOVE
B OESCRIBE WORK ,
Replace windows w�thir. existing openings; �eplace entry doors to build
9 CHAN(iE OF USE FROM o TO
STIPULATIONS
SEPARATE PERMiTS ARE REOUIRED FOR ELECTRICAL, PLUMBING. HEATINC,, TYPE OF CONST.
VEN11LA71NG OR AIF CONOITIONING '
7HIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONINfi
AUTHOR12E0 IS NO7 COMMENCED WtTHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK iS SUSPENDED OR ABANDONEO fOR A PERIOD OF 120 DAYS AT
ANY TIME AFTEfi WOHK IS COMMEIJCED. NO OWLG. UNITS
I HEFlEBY CERTIfV THAT I HAVE iiEAD AND EXAMINED THIS APPLICAiION
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yp�UATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO
WITM WME7HEF SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �S7 ��FOO
DOES NOT PRESUME TO GIVE AU7MORI7Y TO VIOLATE OR CANCEL THE pEFMiT FEE
PROVISIONS OF ANY OTHEFi STA7E R LOCAL LAW REGULATING CON-
TRU TION Fi TME PERFO A F CONSTRUCTION $699 .%S
PLAN CMECK FEE
�0 3 C1'
�GNATUpE NCNACTQAOAAU�MpqIjEOAGENT OATE� MEN PRC
$�GNaTUpE O� OwtiEp ��� O�NNEp BU0.0Epi iDATE� 8�OL" �NS
V
GROUP
fT
CU FT.
OFFSTREET PARKING
STAl,LS GAAAGES
SURTAX
�28.%0
SAC CNARGE
Fire SC $57.40
TOTALFEE
$785.85 (
r vnuon
ERMIT
LOAD
CITY OF FRIDLEY Effective 1/1/2003
6431 University Ave NE R-3, COMMERCIAL & INDUSTRIAL �
Fridley, MN 55432 BUILDING PERMIT APPLICATION
(763) 572-3604 FAX (763) 571-1287
CONSTRUCTION ADDRESS �5�� �`"�.5%� C ��ti,G�i �� Zoning
Legal
Owner & Address Tel# ( )
CONTRACTOR & ADDRESS +��YIC� L,4.('.,1� ��'C � Tel# (%'S2 ) z S3 d'09' %
��d� cvure �� �.,o� ��-�.4 � � �ss��s L'z�`i � �
Architect ��� Reg.# Engineer Reg.#
BUILDING CONSTRUCTION
TYPE OF WORK C] New [] Addition � Alteration -Describe
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OFC. AREA: Length Width
WHSE AREA: Length� Width
OTHER AREA: Length Width
Height Sq.
Height Sq.
Height Sq.
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Ft. �
Ft.
Ft.
APPLICANT ��'�Y °-rC �n ��j`� Tel ��Z ZS3 � P7Date � / � �-3
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VALUATION �
Sq. Ft, x$ Cost/Sq. Ft. = Valuation $ )
Sq. Ft. x S Cost/Sq. Ft. = Valuation $ )_$ S� �° �
Sq. Ft. x$ Cost/Sq. Ft. = Valuation $ ) TOTAL VALUE
Building Use Construction Type Occupancy Group
Air Conditioning []Yes []No Fire Protection Provided []Yes []No
Performance Bond Amount $ See Reverse for Schedule Received'[)Yes []No
PERMIT FEES
Permit Fee .$ . S� See Fee Schedule on Reverse Side
Plan Check $ In Excess of Prepaid Amount - See Reverse Side
Fire Surcharge $ �� .001 x Permit Valuation (1/lOth �)
State Surcharge $ � � D $,50/51,000 Valuation (See Sched. for >$1 Million)
SAC Charge S $1275 per SAC Unit (Plans to MWCC for determination)
Erosion Control $'' $450.00 Conservation Plan Review
Park Fee $ � Fee Determined By Engineering
Spec. Assessments $ Agreement Necessary [] Not Necessary [�
Curb Cut Escrow $ ' �, feet x 517.00/foot
TOTAL $ • gs c
'�' � o� c� �� ATTACH STI PU LATI ONS
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PLUMBING
COMMERCIAL APPLICATION
City of Fridley
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Pe umber
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ate Received j
DATE YOUR E-MAIL ADDRESS
srre au�rtess 6 .S � I �.I�c ., ,� �..1 CZ �,Q
TENANT � � SUITE NO.
. NAME
PROPERTY OWNER/ ppDRESS �
TENANT
CIT1f � STATE ��� ZIP �.�
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PHONE # �
NAME �G� �.° S{l ✓< < � � LICENSE #
ADDRESS 3 � � � e � a. �/
COWTRACTOR CITY c I c STATE �l �° ZIP '�S ���
. PHONE # � � � � a— � °`� � � FAX
PERMIT TYPE ❑ INST'ITUTIONAL ❑ MULTI-FAMILY ❑ SWIMMING POOL
❑ TOWNHOUSE ❑ COMMERCIAUINDUSTRIAL ❑ OTHER
TYPE OF WORK ❑ NEW ❑ REPLACEMENT ❑ ALT./REMODEL
DETAILED DESCRIPTION OF WORK �
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FIXTURES: (INDICATE TOTAL NUMBER OF EACH)
FEES BASED ON $10 PER FIXTURE, EXCEPT WHERE MOTED URINAL
CLOTHES WASH FLOOR DRAINS RPZ VALVE/ ($15)
DISHWASHER GAS PIPING BACKFLOW PREV.
WATER HEATER ($35)
DRINKINC FOIiEFTAIN GREASE TRAP ROOF DRAINS �ATER METER
FAUCET �KITCHEN SINK SHOWER WATER PIPING
FLAMMABLE WASTE LAUNDRY TRAY SLOP SINK
WATER SOF'I'ENER ($35)
TANK LAVATORY SIMMMING POOL �ATER CLOSET
Permit Fee
Plan Review
Surcharge
Total Due
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$ �5 �
Minimum: $35.00
$.50 on permits less than $1,000
Make Checks Payable to: City of Fridley
THIS IS AN APPLICATION FOR A PERMIT — PIOT VALID UNTIL PROCESSED
I hereby apply far a plumbing permit and I acknowledge that the informaUon above is complete and accurate; that the work vv�ll be in conformance witt� the
ordinances and codes of the City of Fridiey and with the Minnesota Constructlon Codes; that 1 understand this ls not a permit but only an applip�on for a
permft and work is not to start without a perm�; that the work will be in accordance with the approved pian in the case of all work which requires revievv and
approval of plans.
NAME OF APPLICANT � � t� � �
SIGNATURE OF
DATE � ! _26l`, 6
DF FRIDLEY COMMUNITY DEVELOPMENT DEPARTMENT
6437 UNIVERSITY AVENUE NE, FRIDLEY, MN 55432
(763) 572-3604