AF - 36486City of Fridley, Mirm..
BUILDING PERMIT
Da�;_ September 29, 1970
Qp�p; Frank T.c�y�; g B�� Sa.IIle
Address ��Q�h��+P1 Raad � E Add�ss Same
6.3�s 37
..� �- ---,
N° i0846
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LOCATION OF BUILDING
No. 66�Q_ ��t Channel Road part of Lot _
Lot — ___ Block Addition or Sub-Division __._.._,
Corner Lot — Inside Lot - X Setback __._ Sideyard
Sewer Elevation
Founda.tion IIevation
DESCRIPTION OF BUILDING
To be vsea as:
Rpr'oof i n� � Front Depth Height
Sq. Ft Cu. F't
Front Depth FTeight Sq, Ft, Cu, Ft,
Type of Constructioa Es� Cos� �._�.300. 00 _ To be Completed _ Nov lst, 1970
In c,ons�tderation oP the issuance to me of a germit to construct the building described above, Y agree fo do
th� proposed work in acoorda.nce with the description above set forYh and in compltance with all provisiona of
ordiaancea of the dty of FrYdley. �
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In consideration of fhe payment of a fee of $_.._S...QO , permit is hereby granted to �='s • Fxank Lewis
to construct the buflding or addition as described a'bove. This�rm� t is granted upon
the express condition t�hat the person to whom it is granted aad his agents, employees anc� workmen, in all work
done in, around and u�n said building, or anY Part thereof, shall conform in all reapects tfl the ordinances of
FridleY, Minnesota regarclfnp lacation, construction, alteration, maiatenance, repair and movfn� of buildings
within the dty ]imits and th�s permit may be revoked at any time upon violation of any of the provfs�tons oP said
ordinanc�.
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Nonc�
This psrmM doas not eovar ths �oestrudioe, testalFalloe ier mtrlag, plumbteB� 9+� 6estin9, ssw�r ee w�s�. B� sura fo rss
�ha 8nildlua Inapseto� to� aparats permhi fo� t6as hNea.
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APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
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NO • . P„ � �� S TREET :
LOT: BLOCK: ADDITION•
CORNEIZ LOT: INSIDE LOT:�SETBACK: SIDEYARD;`__
AppliCant attach to this form Ttao Certificates of Survey of Lot and propoaed
building location drawn on these Certificates.
BESCRTPTION OF BUILDING
To Be Used As:
t �
Front• Depth; Height•
Square Feet: Cubic Feet:
.._._ _ Front: Depth; Height:
Square Feet; Cubic Feet:
�pe of Construction; � p--�
Estimated Cost:_$ � �
To Be Completed; _ �/��- � �I '
The undersigned hereby makes applicativn for a permit for the work herein
specified, agxeeing to do all work in stiict accordance with the City of
Fridley qrdinances and rulings of the Department of Buildings, aad hereby
declares that all the facts and representations stated in thia application
are true aad correct.
�DATE: ��_ �� a ' SIGNATURE: .
(See Reverae Side For Additioaal Information.)
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any existing
building or structure, or for any alteration or repairs to any existing
building or structure, upon application therefore, xequire the payment by the
applicant for such permit of fees to the amouat herein below set forth and in
the manner herein provided to-wit:
UIVIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building pe�its, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average*
height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In no case sha11 the fee charged for any permit as set forth in Section 2 be
lesa than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours from the
time of application, to allaw for proper review of the proposed structure and '
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceedin� with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy qf any structure for which a building permit has been
issued; and said structure shall not be uaed or occup�ed until a Certificate
of Occupaacy has b�en issued. •
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,
sue�ecr PER NO.
City of Fridley 2 0 6 4
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
f
1 1
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COMMUtJITY DEVELOPMENT DIV. �� �� �
r � ~ •� PROTECTIVE INSPECTION SEC.
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`'-_•� �'��,`; CITY HALL FRIDLEY 55432 NUMBER REV. OATE PAGE OF APPROVED BV
i 612-571-3450 910-F15 10%22/'90 / /
JOB ADDRESS 6630 Channel Road N.E.
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. P"t. 2� �xookview Addition SHEET
2 PROPERTY OWNER MAIL ADDRES$ ZIP PHONE
Realty �7orld
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Qui.mby Com.pany 1132 �'tinson Blvd. , Mpls. MN 55413 378--1170
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
X
8 OESCRIBE WOHK
Reroof Dwelling (12 S ua,x^es:)
9 CHANGEOFUSEFROM TO
STIPULATIONS
On all n.ew roofs or tear•oifs anti rep1acement roOfSe
Stade Co�e requ�res fih�i 2 Iayers o# i� 8b. felt,
r�e��.r1 ���gether, be ins�a�l�d �o a pai�i 2� inches
up fro�n e�ierior wal� line, or the use ot �ther
appr�ved ur�derlaymenf inembranea
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $��� +� � 5O
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF NY OT R STATE OR LOCAL LAW REGULATING CON-
STRUCTION HE P CE OP C NSTRUCTION. S�.%.00
v PLAN CHECK FEE TOTAL FEE
[ � � lY.'G ..S'G' ��. .,S`Z8e �.Q
• SIGNATUREOFCONTPACTORORAUTHORIZEDAGENT IDATEI yµ �� N PRO E T HIS IS YOUR PERMIT
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SiGNATURE OF OWNER��F OWNER BUILDERI IDATEI �pT
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ALTEEt [ ],
corLStruction �.�:
R-1 AND 1�2
F� � i 1 dirx3 Piermi.t Applicatioa'i
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Effective 8/16/90
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i�fi, 2 a
Legal Description: �} c .e�a �ti,
Owt�x' Name & ��? �; ��-� �t � �. #
Cbr�tractor: _ �U ��'I l3 y C� � P Te1. # 3 7� � � 7G
Address: . / � 3 �- S %`� � s �-✓ ��✓� � �� �S •
Attach to this ap�licatioa7, a Certi,ficate of SuYVey of the
lot, with the pro�osed �ctiari drawn aaz it to scate.
AFSC,RIP'1'I�J OF 71�'!m{ � �
LZ�TIIJG ARE�: Iength Width Height Sq. Ft.
Q�R�GE AREA: Lexigth Width Height Sq. Ft.
DDCR ARE�: Ler�gth � Width Figt/Gro�u�d Sq. Ft.
OTI�R• _ / � �
.
Corner Lpt [] Inside Iot [] Ft. Yd Setback� Side Yard Setbacks
� of Construction: ✓...�--Q9S Fstimated C7ost: $ � ��-`.
Approx. Ccanpletion Uate: P�-- Z G- 90 � OQ
Proposed Driveway Width If New Openiriy Desir+ed; Ft. $ $
� Width + 6' See Hack Page
n�: f �� z � a xe�c�,tv�r: Te1. #� 7 FS �� 7 a
P�ermit Fee $ J ! • � f�
Fire Surchan�e $ • �o l5
State s�rcharcle $ .� U
SAC Criarge $
Driveway Escraw $
Park Fee $
Sewer Main Ct�aYge $
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CITY IISE �Y
Fee Sc�le a�n Reverse Side
.001 x P+ennit valuation (1/loth �)
$.5o/Sl,000 valuation
$600 pex SAC Unit
Alt. °An OY' Alt. nBn Above
Fee Determirted bY �gineeritxJ
Agre�ent Nec�ssary [ ] Not Nec.�ssa�y [ ]
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�he Chief Huilding Offici.al shall, before iss�irig permits for the er�tioaz of any
b�ilding or structure, or for ariy addition to any existing building or structure. or
for ariy altetation or repair t.o ariy existirig building or structure, upon ap�lication
therefore, require the payment by the applicant for such �n++;t of fees to the am�nt
iier+ein belaw set forth and in the manner herein provided to wit:
� Z�0►�L VALUE
$1 t�o $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $5Q0,000
��+�,a.
$15 (M�ninnun Fee is $15 plus suxrharge)
$15 for first $500 plus $2 for each additional $100 or
fraction thereof, to and iricluding $2,000
$45 for fixst $2,000 plus $9 for each additional $1,000
or fraction thereof, to and includirig $25,000
$252 for first $25,000 plus $6.50 for each additional $1,000
or fraction thereof, to and incl� $50,000
$414.50 for first $50,000 plus $4.50 for each additional
$1,000 or fraction thereof, to and including $100,b00
$639.50 for first $100,000 plus $3.50 for each additional
$1,000 or fraction thereof, to ar�d including $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $3539.50 for the fizst $1,000,000 plus $2 for each additional
$1,000 or fraction thereof
DRIVE�iY DEPRESSION ESCROW
(Concrete Curb Streets On1Y)
Alt�ernate ��p,�� : Removal and replacement of curb ar�d gutter only - Driveway width plus
6 feet tiines $13.50.
Alternate "B"; Remaval and replacement of curb arid gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
• �• ■ v� •i • � • �i ��,• •;
Permits for oonstruction will be issued a m�*+�m►� of 24 hours fran the time of
application t� allvw for proper review of the pro�os� stnictu?�e arid of the
construction site.
A Certificate of SuYVey of the lot, showing the location of the foundation once it has
it has be�n constructed will be required before proczading with t11e frami.ng.
�
SUBJECT pE
c�ty of Fridley 2 O 9 3 O
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i �
' � ECEIPT NO
� `4 �_��� COMMUtJITY OEVELOPMENT DIV.
r j � PROTECTIVE INSPECTION SEC. ��9 9�
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l.-__� /"'1.� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV
s� � � 612-571-3450 910-Ft 5 7/9/91 / /
JOB ApDRESS 6630 Channel Road NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. Pt• 29. B.rookvie�a Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Barb/Pete Keith. 6630 Channel Road NE 574-7493
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILAODRESS ZIP PHONE IICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW C� ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 24' x 12�.DETACHED Deck
9 CHANGEQFUSEFROM TO
STI PU LATIONS
See. notati.ons on plan.
SEPARATE PERMITS ARE REOUIRED 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 PEHIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1' STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUfiTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2,35Q $I..�S
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $rjL,�.00 Fire SC $2.3rJ
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
$57,53
UREOFCONiRACTORORAUT ORI OAGE T (DATEI N PR P V I TED THIS IS YOUR PERM�T
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i NAT REOFOWNEAI�FOWNE BUILDERI iDATEI BLDG INSP �ATE
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Oca�.,�'ttuctian Add�ss:
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R�l AND 1�-2
Buildiryg Permit Applicatian
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EffeCtive 1,/1,/91
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o� x� & Aaa�: �� r !-� �- ��t-P I�e �' -�-�, �. � �� � - �7 `-��► �3
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Attach to this applicaticci, a Qertificate of S�vey of the
lat, with the ptropo�ed oonstn�cticai drawn cri it to scale.
u :.-_ w; � �y � � ��� �..�'.c �i'i�-.,i:�.�
LI�i�' i�l: �tl W�C3�1 �j.C�l't ►SCj. I''t.
�iRi�E ARF�I: IPi]C�'1 � W�CI�l Ii21C�'lt �$Cj. I''t.
DBQt ARE�i: Iel�gth � Width � Hgt�Grotu'�d �`� Sq. F't. �
O�t: �4�'ac�� �1 S� .�S'i ��i r��7�,� p�9 P;���1 .��
�1�� �o�� � "���
tbrner Iat [] Ir�side Iat [] F`�. Setback Side Yazd Sethacks
Zj�pe of C�iaai: re�i-ea� 1ll�OP�� �'stimated cbst: $ 1 '���- ��
Approx. �letiaal Date:
Prc�posea nriveway wiatn rf rTew openi� Is Desirea: Ft. $ S
Width + 6' See Back Paqe
�,TE: � APPLICAtV'r: Z�el. # .�'7 � % � % 7"� �
�t F� $ u
Fire Surci�arge $
State Sumharge $ � .,
SAC C�ge $
Driveway Fscrow $
Park Fee $
Sew�s Main C�aYge $
�., $ S7 �� �
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Fee Sd�e�.ile an Reverse Sicie
.001 x P�ermit Valuatioai (1/lOth $)
S • 5o/Sl, �o valuatian
$650 per SAC Unit
Alt. �A" or Alt. pB" Ai�ove
� i]aA-or�ni r�xi }� �i rw�ri 7
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itpe Chief Huildirg Official ehall, befare iesuirrg permits far tt�e ere�etioaz of ariy
�,; i dit�g or sttuctur+e, ar� fos any addit3an to any exist,inq buildir�4 a�' s�c�re, or
for any alteration ar repair tc any existit�q buildirr3 or stnycture, upoaz aPPlicatiaaz
therefore, require the PaYment bY � ePPlicant for eud� pezmi.t of fees to ti�e a�uit
her�e3tz belcw set foxth arri it�- the �*,r,ar i�erejn p�ovided t�o-�wit:
Z�0►I�iL VAILTE
$1 to $500
$501 to $2, �0
$2,001 tfl $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
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$15 (Mini�n Fee is $15 Plus �)
$15 for first $500 plus $2 for each azYlitiaa�al $100 or
fractio�► tl�eraof, to ar�d ir�ludir�g $2, 000
$45 for fit�t $2, 000 plus $9 for eacii additioa3al $1.000
a� fractica� tllereof, t,p at�d i*+r1 uding $25, 000
$252 fas fitst 525� 000 Plus $6.50 for each aciditioe'ial $1, 000
OI' �TdCtiC[1 �Ie1'�of , t0 SI1d 31IC1uc�iTlq $50 r 000
$414.50 far fiYSt $50,�0 plus $4.50 for each additional
$1, o00 or fractian thereof, to ar�a 3ncluclirg S1oo, o00
$639.50 for first $1�,000 plus $3.50 for each additional
$l, 000 or fractioai ti�x�eof, to azxi ir�cludirig $500, 000
$500,001 to $1,000,000 $2039.50 for tl�e fiYSt $500,000 plus $3 for eac� additional
$1, �0 oZ' frdCtiaai thex'�eof, to arid it'�cludisyg $l, 000, 000
$1, 000, 001 arid up $3539.50 for the first $1, 000, 000 plus $2 for each addi.tional
$l, 000 os fractiaai thereof
�tIVE�if �SI�T �.R�W
(Ooa�cr�te � Stieets �nl.Y)
Alternate ��p,�� : Rs�oval and re�laoe�ment of cu� at�d gutter only - Drive�ray width plus
6 feet times $13.50.
Alternate "B" : Reaoval and r�lao�e�t of wrb ani gutter ar�d install a 3 foot wide
approadi with 6 inc�i de�th -�iveway width plus 6 feet times $15.75.
� �I' •` �+. • •I" ".�'ll .i�`� •.
P�ermits for ao�ctiaai will be issued a minim�mi of 24 hairs fr� the time of
applicatiaaz to allaw for grop�r review of tl�e p�vposed st�cture arid of the
oo�iaaz site.
A Oertificate of �nvey of the lot, st�owing the location of the fau�dation oa�oe it has
it has been oan.structed will be raquired before pYOOeedir�g with the fra�irrg.
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CHIlVINEy AND STACK VERiFICATION
The undersigned herebY verifies that the existang_ chunney or stack:
1. Has been carefiilly examined Yes (�� No i)
2.
�3.
4.
5.
6
7.
Q
Is free from nist or deterioration
Has no foreign objects lodged within
Is securely supported .
lVieets all current Code requirements for size
and total BTiJ's conn€�ted
` Has total heating BTU's of ��l�B (�
All other BTiJ's �
TOTAL BTU's ��� A D
Has a liner been provided for water heater
Has combustion air been provided for water heater
Remarks: .
List ALTERATIONS Bein� Done: ���;� ����
/�.�,�.l�nr�
_
�
HEATING CO:
Signed By:
Date:
yes (�) No ( )
yes (�) No ( )
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SUBJECT
City of Fridley ,p
, AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
;,
.�
� ; v �_�_ COMMUtJITY OEVELOPMENT DIV.
f � � PROTECTIVE INSPECTION SEC.
� ` �
l-�_�� ��"" ��� CITY HALL FqIDLE� 55432 NUeneER REV DATE PAGE OF
�' 612-571-34b0 910-Ft5 8/21/98 ` / /
JOB ADDRESS
6630 Channel Rd NE
1 LEGAL �OT NO. BLOCK TRACT OR ADOITION
DESCR. P't, 29 B kvi Add
OWNER
3 CONTRACTOR
Owner
4 ARCHITECT OR DESIGNER
5 ENGINEER
fi USE OF BUILDING
Residential
7 CLASS OF WORK
B DESCRIBE WOFK
Replace s:
9 CHANOE OF USE FROM
roo ew ition
MAIL ADDRES$
MAIL ADORESS
MAIL ADDRESS
MAIL ADDRESS
?ERMIT NO.
27329
���1E�
APPROVED BV
SEE ATTACHED
SHEET
ZiP PNONE
571_1608
Z�P PHONE LICENSE NO.
,5G.�9
ZIP PHONE LICENSE NO.
ZIP PHONE LICENSE NO.
❑ NEW ❑ ADDITION ❑ ALTERATION L,� REPAIR p MOVE ❑ REMOVE
on west side - st
TO
STIPULATIONS
Call for building wrap inspection before covering.
I SEPARATE PERMITS ARE REOUIRED fOR ELECTRICAL, PLUMBING, HEATING, � irc vr wno�.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OF WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCEO. NO. DWLG. UNITS
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINEO THIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS yALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEHEIN OR NOT. THE GRANTING OF A PERMIT $499
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION �2]..00
� PLAN CHECK FEE
GNATURE OF CON7RACTOR OR AUTHOAl2ED AGENT IpATEI
,� � , '�� _ �)��,�.� �1�� la�- E�
i
STALLS
ROUP OCCUPANCYLOAD
CU. FT.
OFFSTREET PARKING
IGARAGES
� � J V
SAC CMARGE
Fire SC $.50
TO AL FEE
Z.oa
D THIS IS UR PERMI
i ��=�—L—
4�.TE
NEV� • ^ [ ]
��N [ l
ALTER [ ]
ConstructionAddress :
Legal Description:
Owner Name & Address:
Contractor: �o i
Address
CITY OF FRIDLEY
5INGLE FAMILY A1vD DiJpLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Q
�� �ri�Iecr �°1N
Effective 1/1/98
3a�
�'°j
_� ro,ccU �J� o v� e� L� � o(�� n nel Tel. # s'� /-!�o g
n
MN LICENSE #
Attach to this application, a Certi�cate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF II��IPROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length _ Width Hgt/Grouncl Sq. Ft.
�� -�
OTHER: �, i/�JZ_f�� i��%'�b'i ✓-�� � � c:x/c s ,% � �� � �
Construction Type: V l�� U 1� d�, t�2q Estunated Cost: $ �% ��, �°
(Fee Schedule on Back)
Driveway C�rb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: $ cZ 1� APPLICANT: �-e S P- �%OL f�i�r� Tel. ���� -1(0 ��
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Chazge
TOTAL
STTPULATIONS:
$
$
$,
$,
$.
$.
$
$
$
o�/� UG
��
S?�
$ ��. c�o
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 [ ]
_ • .��
BUII.DING PERMIT FEE SCHEDULE
The Chief Building O�cial 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
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $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
$1,0(}0 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, Q00
$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 $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minunum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the Iocation of the foundation once it has it has been constructed
will be required before proceeding with the framing.
���
' ' � � SUBJECT . ' P IT NO.
City of Fridley 2 8 2 3 �
�, 57�����'�TME TWINS g� ILDING PERMIT
, � No.
COMMUMITY OEVELOPM�NT DIV.
r � V �� PROTECTIVE INSPECTION SEC. ��(� ���
i_---�� �"' �'i CITY HALL FRIOLE� SS�32 NuMBER REV O�TE P�GE OF AvPqOVED Br
t 612-57�-3a50 s�aF�s 10/13/98 � �
108 ADDRESS 6630 Channel Road NE
1 LEGAL �or No. � 1420) ��'�CK TFiACT Oii AODITION SEE ATTACHED
oesca. pt. 29 Brookview Addition SNEET
2 PROPERTY OWNER MAtL ADpRFS$ ZIP PMONE
Tracy Wagoner 571-1608
3 CONTFACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Ocmer
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE N0
5 ENGINEER MAIL ApDFiE$S ZIP PNONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW � ADDITION � ALTERATIpN p REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Construct a 24° x 20' garage - detached• Remo e exis in. ra e from ro ert
9 CHANOE OF USE FROM TO
STIPULATIONS
See notations on plan.
Provide a hard surface driveway.
TYPH OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS AqE REQUIRED FOF ELECTRICAL, PLUMBING. HEATING.
VENTILATING OFi AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTFiUGTION 20NING SQ. FT CU FT
AUTHORI2ED IS NOT COMMENCED V�1ITHIN 80 DAYS. OR If CONSTRUCTION
OR WORK IS SUSPENDEO Oii ABANDONED FOR A PERIOD OF 12p DAYS A7
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OiFSTREET PARKtNG
1 HEREBY CERTIFV THAT I HAYE REAO AND EXAMIN�O THIS APP�ICATION STALIS GARAGES
AND KNOW THE SAME TO BE TRUE AND COAR�CT. ALL PROVISIQNS OF LAWS VALUATION SURTAX
AN� ORDINANCES GOVERNING THIS TVPE OF WOFK WILL QE COMPUEp
WITH WMETHEF SPECIFIED HERE�N OR NOT. THE GRANTING Of A PERMIT 9120 �F.SO
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CAMCEL THE pERMIT FEE SAC CMARGE
PROVISIONS OF ANY 07HER STATE OR LOCAL LAW REGUTATING CON-
STRUCTION OR TME PERFOfiMANCE OF CONSTRUCTION ],(2.25 Fir SC 9.00
PIAN CHECK FEE Tp L FEE
'�/.��- '���r� ��1 � 3 I �i �
SiGNntu OF CON-aaCi OA 4U�MOA�2ED oGENT �DATE� EN RO l VAUD E THIS IS VOUR PERMIT
� �/ .
S�GN4TUREO�OWNEAi��OWNEABURDEp� �DATE� � BL �NS� � ��6fE
NEW � [ ]
ADDN [ ]
ALTER [ ]
Effective 1/1/98
CITY OF FRIDLEY
S�TGLE FA1�III,Y AND DLTpLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION , �7`�
� ��;
ConstructionAddress: t��� (�v�Q�� ` �� � ��'
Legal Description: _�-.f -; 2� t�ao IC i r- � 6Q c� c�
Owner Name & Address: j y� � � � ���c.L,, � ,� Tel. # ,� °� ! -1 Ioc
Contractor: 5�, j j— MN LICENSE #
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
I.ength W idth Height
Length Z� Width Zc Height �
Length Width Hgt/Ground
�
�t?ve e.�t �`�'f� v� L �C��.�n � s2 '
�
Tel. #
Sq. Ft.
Sq. Ft. c:�
Sq. Ft.
Construction Type: ��,��� p���e�,e c� �,��v�e. Estimated Cost: $ -� �- ' ! /��
(Fee Schedule on Back�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$
_$
�
DATE: _ I C/ I.3 /�� APPLICANT: �° (,� ; Tel. # 5 7 i- I��' ��
,
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ / �. ���
$ � . �� C�
$_ 6 � Z,
$
$
$
$
$
$
$ l S %s
CITY USE ONLY
Fee Schedule an 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 [ J
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or stnzcture, or for
any, .addition to any existing building or structure, or for any alteration or repair to any existing building or
str,ucture, upon application therefore, require the payment by the applicant for such permit of fees to the amount
h�rein below set forth and in the manner herein provided to-wit:
.r'
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$SO,QO1 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
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $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 �rst $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, tQ 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)
Altemate "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.
�_ � y * _
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ADDRESS
PIN
LEGAL DESC
PERNIIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 l�'AX:
: 6630 CHANNEL RD NE
: 133024240036
: LINAVAILABLE
: LOT BLOCK
: BUII.,DING
: RESIDENTIAL
: WINDOW/DOOR REPL
571-1287
PERMIT O.: 2004-00806 \
__��--�
DATE ISSUED: 06/Ol/2004
VALUATION : $ 1,000.00
NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF TI� DWELLING PER R317
OF TI� 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL ECTERIOR OPENII�TGS.
REPLACE 3 WINDOWS WITHIN EXISTING OPENINGS.
APPLICANT
MCGINNIS RYAN G& THORESON J J
6630 CHANNEL RD NE
FRIDLEY, MN 55432
,� .I►1 :
MCGINNIS RYAN G& THORESON J J
6630 CHANNEL RD 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 wor�
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
�
C�TT A T A TT TTTI �iTn r
BUILDING PERNIIT FEE
FIRE SURCHARGE
STATESURCHARGE,VALUE
TOTAL
PAID WITH CHECK # 3211
..�.� � u.. � i i. i i.iv�u i � iu:,� � uLL:.v i'vl� vr v1t1s v 1 t1GiC 1 riLi1V L�.�l.iC1t3L" L AtS V V L" .
38.75
1.00
0.50
40.25
N�y �� CITY OF FRIDLEY ��� � Effective 4/1i2004
ADDN [] 6431 University Ave NE, Fridley, MN 5543 (763) 572-3604 Bldg Insp
q�-�R [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION ��, J � ���� �
� J��
Construction Address: �� � � � � � � � � � � � `� �
Legai Description:
Ovmer Name 8� Address:
�„ � �, ' �., � - ��
Tel. # �a �mi z � � �� °
Contractor. �e L� MN LICENSE # --
Address: �' Tel. #
LMNG �AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Cert�cate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length
Length
Width Height Sq. Ft
Width Hgt/Ground Sq. Ft
Construction Type: ���� ���.�.� Estimated Cost: $ /G�� �
Driveway Curb Cut Width Needed: Ft + Ft� Ft x� _$
6 %`
DATE: �� � APPLICANT• � �� Tel. # Go a-� 7 CJ -(.��a q
Call (763� 572�604 for Permit Fees if m iling in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Pian Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewrer Main Charge
� vo• ��
$ �__o__
$ �DO
$ •S�
$
.$
$
$
$
$
� \, �
�_—.�
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 Contra�tors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ �% • �S� STIPULATIONS:
BIJIIrDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addidon to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon applica.tion therefore, require the payment by the applicant for such pennit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $5�
$501 to $2,0�
$2,�1 to $25,�
$25,�1 to $50,�0
$50,001 to $100,000
$100,001 to $5�,�
$500,001 to $1,000,000
$1,�,001 and up
FEES
$23.50
$23.50 for first $5(� plus $3.05 for each additional $1� or
fraction thereof, to and including $2,000
$69.25 for first $2,0� plus $14.00 for each additional$1,000
or fraction thereof, to and including $25,� V___ _
$391.25 for first $25,OQ0 plus $10.10 for each additional$1,�0
or fra.ction thereof, to and including $50,�
$543.75 for first $50,� plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,�
$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 $5�,000 plus $4.75 for ea.ch additional
$1,000 or fraction thereof, to and including $1,�,�0
$5,608.75 for the first $1,0�,000 plus $3.15 for each additional
$1,0� or fraction thereof
CURB CUT ESCROW
-(E ��� --- _---- — –
Removal and replacement of �urb and gutter on1Y - driveway width plus 6 feet, times the annuallY determ�ned
rate
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Onlv
� ' = M
3uilding
nspections
763-572-3604
�ATE l`� C1LC�. aC.
;rt� a.nDxESS � C� 3
i HLS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMTT A COPY OF
YOUR STATE LICENSE
WITH APPLICATTON
' PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
0 owr�x co�
NAME:_ IL1 c C�F.-�
ADDRESS: SR��i't l �
PHONE: C�/ oZ- � 3�� -
NAME: I�A�R d /�f�/�-
STATE LICENSE �i �� q �
AnnxESS:1�C�/' Z'�
PHONE S� yYd - �
GLE FAMILYlNEW COT
� T6d0 FAMILYMEW CONS'I
❑ ADDITION
❑ BASEMENT FWISH
❑ DECK
DESCRIBE 9JORK BEING DONE:
SIZE OF IMPROVEMENT
NUMBER OF SQUARES
GARAGFS
PROPOSID SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aiuminum
❑ Other
WINDOWS
IN EXISTING OPENINGS �Yes ONo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WWDOW TO BE INSTALLED
E-MAIL ADDRESS
Pernut No.: ;"�
x���ea By�
Date Rec' d: �i
EXP DATE ` � V �
� � crnr /+ ��Uf/ r�
FAx 7�3 - 7��� � qo 0
� ROOF O DRAIN TILE
❑ SIDING �' I�E '
❑ SWIIvIlvIWG POOL
O HOUSE & GARAGE
O ATfACHED GARAGE
❑ DETACf�D GARAGE
OSoffit
❑ Trim
❑ Fascia
LOCATION OF WINDOWS
NUMBER OF
�
��Zs3 M �
' ��3.�
ZIP,����
BASEMENT REMODELING SUBNIIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List af slTUCtural members to be used
Ft
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCZ-iFS SUBMIT:
l. Site Plan/Survey showing fhe existing structvres
and ProPosed ProJect
2. Two sets of construction pians
3. Energy Calculffiiona
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(L1SIN�THE 1997 j�.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ c�i � Q�°— OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Chazge
Total Due
� � �I . ��'
$
$ , °�
� r. �
� S-�
$
$
$
$
$
$ C� (?
See Back Page for Fee Schedule
65% of Bui(ding Permit Fee
.001 times the total job valua.tion
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acl�owledge 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 permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work whic ires review a�a a roval of plans.
SIGNATURE OF APPLICANT �'�% � PRINT NAME k�/�l !�(� /� DATE P.G 2"��
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 altera.tion 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:
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 proposai stzu.cture and of the construction site.
A Certificate of Survey of the lot, showi.ng the location of the existing founda.tion will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
� '
Building
Inspections
763-572-3604
DATE 'v L
SITE ADDRESS �
THIS APPLICANT IS
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
BUILDIl`TG
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-� IL ADDRESS
� ��1 ad VUOr��I s' S�f ��1 1_T
❑ OWNER ❑CONTRACTOR
NAME: C,�S► ��O�S�
ADDRESS: C9 o c���t o� �� � e
PHONE: C�tZ� �j�— ��pO�
NAME: ii�� �v �6n'Y��, �C�°�/'t CQ,�
STATELICENSE # 1�-- 2OroZ�S J� EXPDATE �"� d7�� �
ADDRESS: �OCg !"�i 0� �Q- CTI'Y�
PHONE ° C��I � G�I �° �O LI O FAX
SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TII,E
❑ DECK ❑ SIDING � O`I'HER
TYPE OF WORK: � ��' ❑ ADDTTION
❑ MAINTENANCE/REPAII2 MODEL]
DESCRIBE WORK BEING DONE: f�°(� Ol/l°r � '��O(
SIZE OF IMPROVEMENT LENGTH
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
� HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
� - • �� _r•��.�'
y�
._ ., ; ,
� •�
��:�;�.�;� .� - .
�: � i�1 1 � ��r.
--
:�'
� . �,a� .. ,. �
HEIGHT
BASEMENT REMODELING SUBMIT•
1. Existing Floor Plan
2. Proposed fl�r plan
3. List of structwal members to be used
Ft.
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑So�t ADDITIONS. & PORCHES SiTBMTI':
❑ Trim 1. Site Plan/Survey showing the existing structurzs
� Fascia and proposed project.
WINDOWS 2. Two sets of construct�on plans
IN EXISTING OPENINGS OYes ONo LOCATION OF WINDOWS 3. Energy Calculations
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 ���97 B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $._ �� �.(�� OCCUPANCY_ TYPE
Permit Fee $ �(,�: � See Back Page for Fee Schedule
Plan Review $ /%,�p 65% of Building Permit Fee
Fire Surcharge $ ;`� .001 times the total job valuation
Stircharge $ .0005 x Permit Valuation Minimum $.50
License Surcharge $ ,�j; (j� $5.00 (State Licensed Residential Contractors)
SAC Charge $ $1675 per SAC Unit (Plans to MWCC for detennination}
Curb Cut Escrow $ ft+ 6 ft= ft x$21 =$
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary () Non Necessary ()
Total Due $ �, Make checks payable to: City of Fridley Attach Stiaulations
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTII. 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 applic for • it rk is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work w r ire d approval of plans.
SIGNATURE OF APPLICAN PRINT NA ��/l � DATE ��� Z( �
�- '
g
�
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Building
Inspections
763-572-3604
DA� rar��zq���
SITE ADDRESS �
7'HIS APPLICANT IS:
PROPERTY
OWNER!
TENANT
CONTRACTOIt
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
PLUMBYNG
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
�n�. Dad �ar�'� ��cS�'
� OWNER CONTRACTOR
� ! C�i 0 P" '� .�0 01 ��c 4t G C� J h�► �
S: �(� U {� D CITY � l� ���
)� —_ �n d dZ.
STATE LICENSE #_
ADDRESS: � � 6
PHONE � S � ` (
�J.SINGLE FAMILY
❑ NEW
DETAILED DESCRIPTION OF WORK
��p�+ NoM�e .S er'v;c�s
� �,'�� EXP DATE �
;e�^ �U /f%� crrY�
- �it D �D FAX
❑ TWO FAMILY
�REPLACEMENT
� TOWNHOUSE
Permit No.:
,_ �
-. :
■� .��. -� :� ^"j �:,--
�
1'E�'v ZIP v ��� y
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, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of tabor )
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 WHETtE NOTED. FIXTURFS: (INDICATE TOTAL
NUMBER OF EACH BELOVI� � SHOWER WATER PIPING
�BATH SINK/LAV _FLOOR DRAINS _
BATHTUB _ GAS PTPING pv�'.o cmGrc.Fr.r�a) SWIMMING POOL WATER �C�FTNER ($35}
CLOTHES WASHER KITCHEN SINK � WATER CLOSET _ BACKFLOW PREV. ($15)
DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
— — WATER METER _ OTHER
Permit Fee
TOTAL DUE $
.�� �:..,,<. : ,�:.:.,., .... _. _
p� 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
Tntal = �.'
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 appli ation for rmi work is not to start without a permit; that the work will be in ac ordanc with the
approved plan in the case of work i ' r w and approval of pl ' s.
SIGNATURE OF APPLICANT PR1NT NAME �^-�� DATE � �� `d*
r
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977