AF - 36537Caty of Fridley, Minn.
BUILDING PEI�MIT
Date: SEPTEMBER 30, 1966
N°
Owner: MANGARD HALVERSON B�d� SUSSEL COMPANY ��
Addresa 67 Ol CHANNEZ ROAD N eE . �,g�.� 185 0 Como Avenue
FRTDLEY, MIlVNESOTA 55432 St, Pau1, Minnesota
3� � l,�'_
9U3�
LOCATION OF BUILDING
No. 6�oi s,�t c� Roan �oE. .� �.. Part of Lot
Lot ._._.. 4� T__ Block Addition or Sub-Division .�.SECOND REV, AUD. SUB. ��21
Corner Lot —_ Inaide Lot —.. Setback �—_ Sideyard ._.
Sewer IIeva�tan
Foundation IIevation
DESCRIPTION OF BUILDING
To be Used as:
Det . Garage �nt _._. Z�" Depth 24 Height 10 �� 576 �� 5, 760
Front Depth I�eight Sq. Ft _.._ Ca. Fk
�j�e of Construction ..._....- F.B�. F�t Cost _...�..z 5.25.—._..__ To be Completed
In consideration oP the 3ssuance to me of a permft to construct the building descrlbed above, I agree to do
the proposed work in accordauce with the d�acript3on above t forth and in co liance with all proviaiona of
ordinanc�s of the dty of Frfdley. �
In considerat[on of the paymeat oP a fee of $ 6.00 ��t is hereby granted to SUSSEL
��� to construct the buflding or addition as described above. Thispe rmft is granted upaa
the express c�ndition that the person to whom it is granted and hia agents, employees and worl�nen, fn all work
done in, around and u�n said building, or anyp� thereof, shall conforra in all reapecta to the orainancea oP
Fridley, Minnesota regardiug location, conatruct�fon, alteration, maintenaace, repair aad moving of builciinge
within the dty lim�its and this permit �ay be revoked at a,ny time upon violation of aay of the provis�tona of said
ordinancres.
('.T�ARFN'CE BELISLE B��, �
Nonc�:
T6b penah dees eot eover t6s coastroetioe, imta0dioe fe� vrUdae. Ph�mb[ng, ea heaHeg, sewsr er water. 8� ams to a�
tlre Buildiag Inspsetor for aparate parmhs Po� them ihms.
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BUILDING PERMIT FEE SGIiEDDLE
SECTION 2. The Inspactor of Suildings shall, before isau2ng any germit for
the erection, of any building or structure, or for any addition to any existing
building or structure, or for any alterations or repairs to any exiseing
building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount hexeia belocv set farth and in
the manner herein provided to-wit;
2.1. �`or any such permit fo� the exection of any fire-proof building,
other tha a garage, warehouse, factory or grain eletra�or, or for the erection
of any fire-proo£ addition, for s3milar occupancy, to any esisting building,
shall be at the rate of $1.40 for.asch one thousand cubic feet, or fraction
thereof, in such cubical contents.
2.2 For any such permit for the erection of any fire-proof garage,
warehouse, factory or grait� elevator, or�for the arection of any fire��proof
addition, for similar occupancyy to any existing building sha11 be at the
rate of $1.25 for each one thousand cubic feet, classified as "fireproof°t
by Section 502 of the Minneap�lis Buflding Code.
IiOIISES
2.3. For any such permit for the erectivn of any non-fireproof
building, other than a garage, warehouso, factory or grain elevator, or
any non-fireproof addition, for �imiiar occupancy, to any existing bui,lding �
permit $1.00 for each one thousand cubic feet.
GARAGES
2.4. For any such permit for the erection of any non-fireproof garage,
warehouse, factory or grain eievator, or for the erection of any non-fire-proof
addition; for s�imilar occupancy, to any esisting buildirxg or for each such
building or addition - ninetq cents ($0.90) for each one thous.and cubic feet
or fraction thereof, in the cubical contents thereof with the minimum of $4.00.
For the purpose of comguting fees for building permita, the cubical contents
of any buildiag or addition to a uniform height throughout by.multiplying the �
ground- area�covered from a goint six (6) inches below the floor line of the
basement ar cellar to the average h�s�ght of th8 upger surface or to the average
height of the roof surface of the main gable of a pitched roof.
2,5. For repairs or alterations to an existing atiru�ture, the fee s:�Pll
be at the rate of.$3.00 per each Five Hundred DoI].are ($500.Op) or fracti+�n
thereof in the cost of alI proposed work.
2.6. . In na case sha11 the fee chargecl for any permit as set forth in
Section 2 be less than $4,.00. .
STORM REPAIR DAMAGE FEES:
Residential:
Co�ercial;
Estimated Cost of work up to $SOO.�J� - S�e!s�
Estimated Cost of work over $5�::,^:>�� �-� ;r;,:,.; ��0
Estimated Cost of wark t:� `�:� �`< ,., :?J -� •�".� "a
Estimatsd�st of wo�S: u�r;:r ;�.:i;'i:°�.vL' � Y1�.�,�
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�?ttruruvr`s (�`,erfifirafr _
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� 7EL�PHONE 927=8953
STATE `: SLIRVEYII�G F
. COMPANY : ` - ,
5710 NEWTON AVENU,E 50. Mt(�lNEAPOLIS; MIfVNES�TA 5541.9_
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i: her�aby certify that thi9.: ia a�rue an�i carrec� represent�ti�in of� � ��
- s�rttey of the-: boundaries afs- Lat 4Ai;� �econd Revieia� Auditoreg �u�divis�i�r�
�to, 21, An�rk� CauntyF Min�estit�a, e.u�b,�e�t to. th�e r3.gf�t af way, of .Channei i
, t Fic�et� over end ecross the West $7 feet.`thereofo i.furth�r cer��fy- tr�..th� '
� Ldcetio� of �e11 buil�fi:ngs on e�id 1.and and �11 v.isible tiu��ding ° I
sncroachment�, if e�ty� from ax oa� said 1endo 5ub1eCt to 3��Stz`iCtit3�s �'
r��eavat�ans and ae�eme�ts of rec�rd�,if.ae�yo ..
As �urveyed by me thss :27�h day of Se�S:�smber,, 196i6"e
. , .���94���" % �Oh4r���!�"'""�„� w _
Minne�ata Reg:�:siration Nt�rritier �852 .
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SUBJECT
c�ty of Fridley _
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ��� ��
r
i �
� � RECEIPT NO.
� `L � COMMUfJITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. ��� r
' • , 1
�
L---- �,�����;.; CI7Y HALL FRIDLE� 55432 NUMBER REV DATE PAGE OF APPRpyEO Bv `
L J` 612-571-3450 910-F15 6/29/95 / �
JOB ADDRESS 6701 Channel Road NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. L►-N Second Rev. Aud. Sub. �i�21 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Walter L Squier 6701 Channel Road NE 571-8408
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS IIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW ❑ ADOITION ❑ ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof House (8 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMB�NG, 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
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OF WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY 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 SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL 8E COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT 6OO .SO
DOES NOT PRESUME TO GIVE AUTHOFITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 1�I.00 Fire SC .GO
PLAN CHECK FEE TOTAL FEE
SIGNAT � E OF CO �� I ACTOR OA AUTHOAIZED AGENT IDATEI ���
) VHEN Pfi�RLY 1y UDATED THIS IS YOUR PEFMIT
�i `� ,.� � t � ' / .
�SiGN RE ER�iFOWNERBUILDERi �DATFp -- BLOG � S� qtiT
NEW [ ]
ADDN [ ]
ALTER []
Construction Address:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
�7 b / C �,� nli.c� ��- ,�i _ /v� r'�' .
Effective 1 / 1 /95
�� ���� �
Lega1 Descripdon: `%�US�
Owner Name &. Address: °GvA��'� � • � vi�2 �7�� ��a�J•v,uE � ��.�r ��'. Tel. # � '/ — � �-/ � �
Contractor: .�y S'�i� ��Lc%4 L'2 �. .�� vr�'�z MN LICENSE #
Address: � �� f �Gi,r�.�-'c� � ,c,.��_ ��2 s��.�-�. -�� Tel. # .� �j -- k i ��-
Attach to this application, a Certificate of Survey of the
lot, with #he pro�s�i construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width
Width
Width
Height
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
���' u.�
Corner L.ot [] Iaside Lot (� Ft. Yd Setback Side Yard Setbacl
Type of Construction: �?c� o�' S�'l �,y c'L�S Estimated Cost: $ C� ('�
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + b t= Ft x$ _$
DATE: �' ^ 2q ' 9 �� APPLICANT: '� Tel. # '�7/ �� yo�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ / � �r�)
$ • �r��
$ s�c�
$
$
$
$
$
$
$ � v �Q
CITY USE ONLY
Fee Schedule on Reverse Side
.�1 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$850 per SAC Unit
$5.(m (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Nec�ssary [ ] Not Necessary [ ]
�;u��.i�yrvc: �>i.Rnrti��� rr_�? SC�[Er�Ur_r_
"l�h� (;hi��f t3uildin}; Ulticial shall, tx;f4cc issuing permits for tt�c crc:clion ot any huilding or titructure,
��r fi�r any aciciiti<�n tu any cxisting buildin}; <�r sEructurc, or for any altcration or rcpa�r to any cxistin�;
1>uiliiing <>r suucture, u�n a�I�lication therefore, require tt�e payment by tl�e a(�p�icant for such �ermit
c�t tcc;s tc� thc: IiIl1011lli hcrcin t�clbw tict fo�ih and in thc inanncn c�ccia prc�vidc;cl to-wil.
"CO"1'AL VAI.U(:
� 1 to $500
$SOi to $2,000
$2,001 to $25,OQ0
�25;001 to �50,000 '
$50,001 to �100,000
$i00,001 to $500,000
$500,001 to $I,OOQ,000� -
$1,000,001 and up
I=ri:S
$IS (Minimum Fce is $15 plus surchairge)
$15 for first $S00 plus $2 for each additxonal $100 or
fracbion thereof, to and including $2,000 �
$45 for fi,�st $2,000 plus $9 for each additionai $1;000
or fraction �ereof, to and including $25,000 '
$252 �for first $25,OOQ pl�s $6_50 far each additional $1;000
or fraction thereof, �o. and includi,ag $50,000
$414_50 for first $SO,OOU plus $4S0 for each additional
$1,000 or fractioa thaeof, to and includiag $i0(},OQO
$63950 for €�rst -$100,000 plus �$3_50 for each additional �
$1,OOU or fraction 1i�eo� to and includiIIg -$500,000
$2039.50 for die 5rst $S�O,UQO pins $3 for each additianal
$1,000 or fraction thereof, to and including $i,000,000
$3539_50 for the firs-t $1,000,0(}0 plus $2 for each additioaai
$1,000 or fractioa thereof -
DRiVEWAY DEPRESS[ON ESCROW
(Concrete CeYUfi Stxeets Only)
Alternate "A": Removal and replacement of curb and gutter o�nly - Ddveway width plus b feet times
�13_50.
Alternate "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_
VLR[F[CA"fION OF FOUNDAT[ON
t'ermits for cor�stiuctio❑ will be issued a miriimum of 24 hours firom the time of a�plication to allow
for proper review of the proposui stnucture and of the construction site_
A Certificate oC Sucvey of ttie lot, showing the iocation of the founciatian once it has it has heen
co��.structui will t�c re;yuirul before proceeding with lhe framing.
u
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D i N G P E R M I
r
� .
� �
� �V _ COMMUNITY DEVELOPMENT OIV.
r � � PROTECTIVE INSPECTION SEC.
, ,
l.-_-� �"' �,� CITY HALL FRIDLE� 55432 NuMeER
i 612-571-3450
910-F15
JOB ADDRESS
6701 Channel Road NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. (f_N Second Re
2 PROPERTY OWNER MAII ADDRESS
Walter Squier 6701 Channel Road NF
3 CONTRACTOR MAILADDRESS
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAILADDHESS
6 USE OF BUILOING
Residential
7 CLASS OF WORK
REV IDATE
7/14/97
ZIP
21P
PAGE OF
� �
PHONE
PHONE
�����9
.BECEIPT NQ-
����-
APPROVED BV
SEE ATTACHED
SHEET
UCENSE NO
LICENSE NO.
LICENSE NO
❑ NEW 0 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
X
8 DESCRIBE WORK
9 CHANGE OF USE FROM
STIPULATIONS
TO
Replacement bedroom windows must meet the State Egress Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
ON WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yqLUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL 8E COMPLIED @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT `I'2s6OO
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PEFiFORMANCE OF CONSTRUCTION. �7�F.JS
SIG OF T ACTORORAUTH0�71ZEDAGENT IDATEI
IiGNA �OWNEF7UFOWNERBUILDER� IDATE�
SO.
STALLS
NCY GROUP OCCUPANCYLOAD
CU. FT.
OFFSTREET PARKING
GARAGES
SURTAX
$1.30
SAC CHARGE
Fire SC $2.60
TOTAL FEE
$78.65
IDATED THIS IS YOUR PERMIT
NEW
ADDN
ALTER
[l
[l
[l
ConstructionAddress: Co
Legai Description:
Owner Name & A
CITY OF FRIDLEY
SINGLE FAMii,y A1�1D DUPLEXES R-1 AND R-Z
BUILDING PERMIT APPLICATION
C�j .�} ^> ^J � L ��F ��,
���o�C,
Effective 1/1/97
����-
o� 4 � •
__'�c-'� _-'%rc�
��. . Tel. # �'7'/ r 8!¢ �
Contractor: �,.� �y,r °
MN LICENSE #
Address: ,�70/ ��,,,,,,K � ��
` Tel. # s�7 / � � y 6 �
Attach to this appiication, a Certifirate of Survey of the
lot, with the proposed construction drawn on it to scale.
3',IVING AREA:
GARAGE AREA;
DECK AREA:
OTHER:
Constru t' T
DESCRII''I'ION OF IlVIPROVEMENT
�n� _ Width Height Sq. Ft.
Leng#h Width Height Sq. Ft.
�nS`� Width Hgt/Ground Sq. Ft.
�i"✓/!� %/ `.-9L �.,-� �A.(�%/yii� �n ...� � _ � �� � � . �
-�_S �x �sri-��
c ion ype. Estimated Cost: $�-�DO , 6 0
(�'ee Schedule nn Back}
Driveway C�rb C�t Width Needed: Ft. + 6 Ft = Ft �x $ _�
DATE: 7—f y—S% APPLICANT: �
Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STiP[_1LA"I'IOIVS:
CITY USE ONLY
�
� �' S Fee Schedule on Reverse Side
4_
�_____� �Cf� .001 of Pennit Vaivarion (l/.lOth%)
�_ �- c� � $.50/$1,000 Vaivation
� $950 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 [ j Not Necessary []
$ °-l��
I3U[LDiNG PERMIT FEE SCE[ED[1L1;
"I'he C.hief Building OfCicial shall, before issuing permits for the erection of any building or structure, or t�r
any addition to any existing bui(ding or structure, or for any alteration or repair to any existing buildinJ �r
stiucture, upon application therefore, require the payment by the applicant far 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,�0
$2,001 to $25,000
$25,001 to $SO,OQO
$50,001 tv $100,000
$100,001 to $5�,000
$5{10,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
�
$21 for first $S00 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,OQD plus $i2.50 for each additional $1,000
or fraction thereof, to and including $25,0�
$349.75 for first $25,� plus $9.00 for each additional $1,(�0
or fracrion thereof, to and including. $50,0�
$574.Z5 for first $50,000 plus $6 25 for each additional
$1,000 or fra.ction thereaf, to and including $1{}0;000
$887.25 for first $10U,� plus $5.00 for each additional
$1,i�0�or fraction #hereo���.to and including $500,�0
$2887.25 for the first $S�,OUO plus $4:25 for each additional
$1,0� or fraction thereof, to and including $1,�;000
$5012.25 for the first $1,OOU,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.>0.
Alternate. "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 $15_75_
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to ailow for pm�er
review of the proposed structure and of the construction site.
�� t;ei-titicate of Survey o#� the lot, showing the location of tlie foundatios� <�nce it has it has heen c��astruc:�.i
«�±;? h� rcuu.ir�eci hct��r-c I�r�,�cc:din`� ���ith t}�c framin�*,.
SUBJECT
c�ty of Fridley �
AT THE TOP OF TME TWINS g U I L D I N G P E R M I T
i `
ICOMMUNITY OEVELOPMENT DIV.
' � v ------�
r � � PROTECTIVE INSPECTION SEC.
� _ �
� �"'1 � CITY HALL FRIDLE� SS432 Nue�BER
�""�'� � ,�' 612-571-3450
s�aF�s
JOB ADDRESS
6701 Chanttel Road NE
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION
DESCR. /a.—N (Par el 1080 Sec REVIS'
2 PROPEFiTY OWNER MAIL AODRES$
Walter L Squier 6701 Channel Road
3 CONTRACTOR MAIL ADDRESS
Same
4 ARCHITECT Oq DESI(3NER MAIL ADDRESS
5 ENGINEER MAIL ADDRESS
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW
8 DESCRIBE WORK
9 CHANGE OF USE fROM
REV DATE PAGE OF
a/22/9� / /
rmTmnn � c. nr.�, �t.,,
21P
PHONE
PHONE
PHONE
2540�
RECEIPT NO.
er
SEE ATTACHED
SHEET
LICENSE NO.
LICENSE NO.
LICENSE NO.
❑ ADDITION O ALTERATION C� REPAIR ❑ MOVE ❑ REMOVE
TO
I STIPULATIONS Install building wrap and have inspection of same unless manufacturer�
specifications state it is not required.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TMPE OF COI
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOR A PER100 OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG.
I HERE9Y CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORFiEC7. ALL PROVISIONS Of LAWS yALUATION
AND OHDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT �1 s �OO
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION �S�F.00
O�N7RACTOR OR AUTMORIZED AGENT IDATEt
.
� OWNEAUFOWNERBU�LDERI iDATE� ��
1
SO.
STALLS
OUP OCCUPANCYLOAD
CU. FT.
FFSTREET PARKING
IGARAGES
URTAX
$.85
AC CHARGE
Fire SC $1.70
07 FEE
6.55
�'HIS IS UR PERMIT
�� �Z-Z -
�)4TE
NEW
ADDN
ALTER
[l
��
��
CITY OF FRIDLEY
SINGLE FA.MILy A1VD DLTpLEXES R-1 AND R-2
BUILDING PERMIT APpLICATION
ConstructionAddress: _ � �6 / Ch9 �� _ � �
Effective l/l/97
- ,
Legal Description: ,�j� �.,,�� �'�2�� —
Owner Name & Address: �I.gG�� � � c;���
— Tel. # 5 %/ f— � � f�
Contractor: � Z �- . vr ,� jZ MN LICENSE #
Address:
Tel. #
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
0
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIP'I'ION OF IMPROVEMENT
Length Width Height Sq. Ft. �� �'su�r4.�
Len� �Vidth Height Sq. Ft. � �'��jv,g�2��5'
�n� �id� HgtlGround Sq. Ft. `�
Construction T e: � � �
YP /�i� � �.�y � � Estimated Cost: $ / 7 DC"�, C'� �'j
(Fee Schedule on Back)
Driveway Curb C�t Width Needed: Ft. + 6. Ft �= Ft x$ � —$
�
DATE: �-- 2 2 - � '1 APPLICANT: I � � `
Tel. # �� % " C� �f � �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
�ewer Main Charge
TOTAL
ST[PULATIONS:
� � �/ C�G�
� e. ��
$ . �, ���
$
$
$ .
$
$
$
$ � � _ � �-�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuafion {1/lOth%)
$.SO/$1,000 Valuadon
$950 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Detemiined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
QU{LDING PF RA�t[`C EEE SCE�EDC't.(�:
"!'lle Cliief Building Official shall, befori; issuing perniits for the erectio�i oi� any building or structure, or f��r
any addition to any existing building or struciure, or for any alteration or repair to any existin� buildin� t?r
structure, upon application therefore, require the payment by the applicant for such perri�it of fees to the amo�int
h�rein below set forth and in the manner herein �rovided to-wit:
TOTAL VALUE
$1 to $500
$SO1 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50, 001 to $100, 000
$lOQ,001 to $500,000
$SOO,OOi to $1,OOQ,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 pius $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 ��0,000
$574.75 for first $50,000 plus $625 for each additional
$1,OQ0 or fraction thereof, to and including $1QQ,000
$887.25 for fust $100,000 plus $5.00 for each addition�.l
$1,�0 or fraction thereof,.to and including $50{?,{}00
$2887.25 for the first $SOO,UQO plus $4.25 for each additional
$1,000 or fra.ction thereof, to and including $1,0OO,OQO
$5012.25 for the fust $i,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 oniy - Drive�vay width plus 6 feet times $13.�0.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach tivith 6 inch depth - Driveway width plus 6 feet times $15.7�.
VERIFICATION OF FOUNDATIO�+'
Ycrznits for construction will be issued a minimum of 24 hours from the time of application to allow �or pro�ur
review of the proposed stiucture and of the construction site.
;i �:�ertiticate of Survev c�f the (�t, sllowin`� the loeation of thc f�undatic��i �17�ce it }�as it h:�s he:�n c�nstT�u�,��_:
,=r�:; h�� r�c�uircd hcfc,rt t�r�,:�•�din4� �c�iti� tl�� t-rami��n-
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CHIlVINEY AND STACB VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully exaznined Yes �} No ()
2. Is &ee from rust or deterioration Yes No O
3. Has no foreign objects lodged within Yes No O
4. Is securely supported Yes ' No ()
5. Meets all current Code requirements for size �n\
- -- - �d is�1 B�U'-s-�n�ecteci-- - - Yes (;,� �d� ( - }
"\
6 Has total heating BTU's of �����
All other BTIJ's �t 01 � �
TOTAL BTU's U� �I�G�
7. Has a liner been provided for water heater Yes () No (�
8. gias combustion air been provided fcr water heater Yes (� No ()
Remarks:
List ALTERATIONS Being Done:
HEATI�TG CO: _ - _
- = - � �.
: Signed ,By: � - - _ -
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