AF - 36547�i��e ef �rfdie�, �f�. ,
BI3ILD�6 F��T �
N° ��� v�� of �ror�r�a� �� s�n+r�s
. .y�l � . . - . � , � .
Owner � �±+ ,, �� ;�
Architect ' Frid?ey, Mfnn,, �'�:� �
Buiider � t
LOCA"�ON C3F B17� �
No.-��� ��,�; street Part of I.atL,. `
i.ot Block Addition Qr Sub-Division : '-. :,
�ES�P��P'�.'��3N f,�F FUiLDIt�G
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Front I?epth Height �tories_ Manuer af Conatruetio++ ;;:_,
� .4 "���
To be used as compTet t� Coa """
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Permit is heret#� grazi c� to to_.r�wr��4���
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the bu�3din , � ' si �e abOVe stRtemt+2f� TliiB pei�itii ie g1r�i�ed
upoa fhe expx cbndi� n h�t ty�on to wi:om it is granted, and i�is agenCs, empioy�ea a�d �t'k.�szen, f� �II .
ihe work done in, aru d and u'pon, said buildt��, or any part th+ereof, shaii cs�afprm in a11're�pect� to the ordi- '
nattces of F'ridiey, 'Minn., regard�tig the constsucti4�� alier�t4as, mai�tenanee, rsg�ir �c3 zriov�nt�' af,'btiiidi�s-'
veiihin ths Gtty limits, and this permit may be revoked at �,ny time u violat3;t�a of �y o�-tha p�wvisi�`Of �id: =•
ordinancea.
�� � �� � � ��� ` . �`����� �� � inapectpx��oi €$i�iTtlings. �°
1�.C'arRL�'P+1�IEl�i'Z' a�1�111.77'SW��1\T ST�'.�:MI'��T , `,
In e�r�sid�rat%�� of �the fssue and deiivery to �e by th� Ix�spectc�r of ��c3�n� of Fr�d��y �f
ihe alaca�e �►�rmit, I hei e�aY agr� to do �he �rrvpas�� t�ork in wec��rc�ance , wrth .:th� d�er���ic�n
�b�ve �et ft�rt% and �cca�c�ing i:ci the provision�s. cf the Qrdin�ne� of F�Iey, �c�, 3aei�g ��u1�r
sworn, I h�reb� sta�e anc� s�� that the facts st�ted by me ar�d canta,in� Yir� the abc�v� per�iit are
true as thereia �tated. °, . ..
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Sui�scri �.nd sworn to before me at F�idlEy, M. �- ta,,
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day a �_A.D. 19�. -.`
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a�tt�e� af ��Ehe v�ge qP F�idley� _ -
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ir� around �anc� u�n seatd°�iuiid#ng, or auy� �r�i �t�qf,; st�,l eoziform: in a1i; re�p�.:t
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� City of Fridley SUBJECT
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i `
� ' COMMUNITY DEVELOPMENT DIV.
r j L � PROTECTIVE INSPECTION SEC.
� � �
l--N� ��"" �'� CITY HALL FRIDLEY 55432 NUMBER REV.
Z 612-560-3450
910-F15
JOB ADDRESS 6710 Cha.nnel Road
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 2 rj Brookview Addition
2 PROPERTY OWNER MAIL ADDRESS
James A. Peterson 6710 Channel Roa.d
3 CONTRACTOR MAIL ADDRESS
same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAILADDRESS
8 USE OF BUILDING
7 CLASS OF WORK
❑ NEW � �DDITION ❑ ALTERATION
8 DESCRIBE WORK
9 CHANGEOFUSEFROM TO
STIPULATIONS
DATE
7/18/75
ZIP
PAGE OF
� �
PHONE
PHONE
PHONE
PHONE
PERM
T° 309
RECEIPT NO.
��/��
APPROVED BV
SEE ATTACHED
SHEET
LICENSE NO.
LICENSE NO.
LICENSE NO.
❑ REPAIR ❑ MOVE � REMOVE
��PER�tTE PER�IITS REQll1R�D F�R �I)RIN�,
HE�T'I�IG. PLUMiBING aND Sl�N�
l. Complete driveway within one yeax.
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.
AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT S%2 S%ZO
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. 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
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pER I EE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � ZO.00
PLAN HECK FEE TOTAL FEE
- 22.8%
si�e�CONT/�TORORAU i iar ���� S HEN PROPER Y V I TED THIS IS Y��ERMIT
� e�
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•APPLICATI�N FOR RLSTDL'NTIAL., ALTL'RATION,
OR AllllITION.BUILDING ��RI�IIT
• ' CITY OF FRIDLEY, I�iINNESOTA .
O�JI�tElt' S NA1�fE : � { :� BuiLV�x : ��''�� � ' �
� ' ADDRESS : U � � - ADDR�SS : ��
NO s . %iU STREET • `'�� .
I�•OT: �%� BLOCl�: . ADDITIOn : „ �i����'LPi��'
CORI�,'ER LOT : INS IDE LOT :�_SETBACK : ,'C SIDLYAP.D :
Applicant 2.ttacr. to this for� T«� Certificates. �f Survey.of Lnt and.proposed
building ].ocation dr�.wn on these Certificates. .
.
Ta Be Used As :
BESCRIPTION OF BUILDING
0
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�� �°�' Fron� : a� Depth :� �� H�ight : 4 Z 32. s�a
•- • o Square Feet: � Cubi.c.Feet:
• R��vo� � � � . � �
�a'�aS��i � �,��nt : Degth • • Height :
� ��IN6 ' - �
•� . Square Feet; Cubi,c Feet: � •- •
' G�i
� 3.j►pe .of �Canstruction: ,���" Estimated Cos�C:_ ��
To� Be Completed: �� � � � �� '�11�a.� � ���. 42 3Z.$a .
• . . � . � - Q1�tnaa,o� . " I� e �U
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�� The undexsisned hereby makes applicativn�for a permit for the work herein
specifiea, agreeing to do all worlc in strict accordance t�ith the City of
� Fxidley Ordinances and rulings ot the DepaxtmenC of Buildings, and her�by
declares that all the facts and representations stated in this application
8xe true and correct. � � � '
. , �
� • 1k4TE: � / � � i� SIGNAT[1ItE: ,
� �See l�everse Side Far Additional Information.)' '
� .• .
lspU �c G�l��� ��U�. .° � . •
. C.� i4� � ,�,��._. °�o � _ . . . ' .
� � ` � ' �, "je i 1, ' �(� . �J D � • ' .
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BUlLll1N� L'.L'lU�ll 1 rLL ���1LliuLC .
� 5ECTION 2. The Inspector oi Buildings shall, betoxe issuis�g pexmits tor the
cxecCion of any building ox structure, ox iox any addition to any existing
building or sL-xucture, or for any a1L-erntion or rcpairs to any exisent�b the
building or struc.turc, upon app�ication therefore, requirc the paym y
applicanC toi such pennit of fees to the air.ount hexein below seC f�rth and i;t
the mannen c�rein pravided to-wit: . . .
UNITOItM EUILDII�G COD�• Type 1, 2& 4-$2.15 for each one thousand cubic
fee�, or iraction �hereof, in such cubieal Fontents. Type 3& 5-$1.85 for
• each one thousand cubic feet. . ..
� � . � ADDITIONAL INFOIt1�7ATI0N
.�or the purpose of ,.omputing fees for building perm3.ts, the cubical contents
of any building or ad.dition, is determined by multiplying�the gxound area
. covexed from a point six (6) inches below the floor line of the basemen�
ox the cellar ta the average heights of the upper surface or to the averagec
height of the•xoof surface of the main gable of a pitched roof.
• For xepairs•or alterat�ons to�an existing structure, the fee shall be at the
• ra�e of $3.00 per each five hundxed�dol.Iars ($500.00) or fraction thereof in
the cost of all proposed work. ' . �
�� � In n� case shall the fee charged for any permit as set forth in Section 2 be
� less than �5:00. •. � � .. . �
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� � VERIFICATION OF`FOUNDATION � �
. � �.
AOTE: Pennits for construction will be issuect.a minimum of 24 hours from fihe
time of application, to allo�a for proper review of the proposed structuxe and,
of the construction sitee : � .. '
A Cextified Survey of the lot, sho�aing the location of the foundaCion, once it
has been constructed, will be required before proceedin� with the fxairiirig. ,
CERT I r I CATE O�F � OCCUPANCY .
d�pplication for a Certiiicate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any stxucture for which a building permit has been
issued; �nd sa�id structure shall noC be used ar occupied until a Certificate
of Occupancy has been issued.. . . • .
i� � ' . .
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land Planning s�����Jt��,.? 6875 Highway No.65 N.E.
Land Surveying �� • • �j Minneapolis�
so�ts res��„9 r�y2l�Z�?PP�I��L�!� •f��2C• Minn. 55432
Civil Engi�eering Telephone 784-6066
Municipal Engineering Engineers & Surveyors A►ea Code 612
Mortgage Loan Survey ior JAMES PETER50N
� Nor�h line o�'�ofi 25, Broo�view Addition
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-135.68 -- ,
5oufh line o.� fihe Nor�h g�.18�'Qeto�' l.ot 25,�rool�vi�w addi
JUNE � 1915
Th�. EaSt l35:�8 �'eet o�' thQ North- 88. I� �'e�t o�'
Lofi 25, grookviQw Addition� Anol�a �ounty ,
Minnesot�. �
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This is o♦rue and corract representation of o survay of the boundories of the lond above described and ofthe
locefion oi a11 buildings� i/ onJr� fhereon� ond aIl visibla encroachments� if any� �rom or on soid land. -This survey is
made only in connection wiTh o mortgage loon now Fseing placed on the proper�y and no liabilitr is assumed
eaecepf to the holder of such mortgage or any other interest acquired by fhe reason oi such mortgnge. If is
understood and agreed hpj monumep ts have been IPced for the p�rpose of estabHshing Iot lines or boundory
corners. Oated this 1'��day of J�� �t- `' A. D. 19� . '
SUBURBAN- ENGINEERIN�, INC.
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� SuBJECT P NO.
c�ty of Fridley � 2 7 2 9 2
AT THE TOP OF TME TWINS g U I L D I N G P E R M I T
r
� � COMMUNITY DEVELOPMENT DIV. RECEIPT N�%�
i `1i - a.lV
r � � PR��TECTIVE INSPECTION SEC.
i i �
� /"'1 � CITY HALL FRIDLE� 85432 NUMBER REV DATE PAGE OF APPROVED BY
�'"'"� � �'� 612-571-3450 910-F15
8/19/98 / /
108 ADDRESS
6710 Channel Road NE
1 LEGAL �OT NO. BLOCK TRACT OF; ADDITION SEE ATTACHED
DESCFi. 2S 12701 Brookview Addit on SHEET
2 PROPERTY OWNER MAIL AODRES$ 21P PHONE
Ed Holland
3 CONTqACTOR MAILADDRESS ZIP PHONE LICENSENO.
Town & Countr Ro fin _
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house anil ara e
8 CHANGE QF USE FROM TO
STIPULATIONS
Underlayment mu�t comply with the State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING,
VENTILATING OR AIR CONDITI�NING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS CC+MMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HA\/E FiEAD ANO EXAMINED THIS APPLICATION STAlLS GARAGES
AND KNOW THE SAME TO BE THUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOiiK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1501 . ZO .%S
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOC AW REGULATING CON-
STRUCTION OR THE PERFORMANC CO STRU TION �S I. ZS Fire SC I. SO
`�j PLAN CHECK FEE TOTAL FEE
v
Licens 5.00 .50
S� UAEOF NTR CTO QRAUT IZEDAGENT iDATEI N OPE ALIDA THIS IS UR PE
� `
SiGNATURE OF OWNER i�i OWNER BUILDEFi �DATEi BL iNSp pi E
p' w
AUG-13-1998
....... � �
ADDN ( ]
AL1'ER [ )
08�42 FRaM CITY QF FRIDI.EY
CoasnuctionAddress ��
Legal Description:
Owner Aiame & Addr�ess:
Concract�r• �I
Aa��: �1 M �1 �.n
TO
CITY OF �'RIDLEY
SINCLE FAMYiY AND DUPLEXES Yt 1 AND R-2
BiJILDING PERNIIT ppPLICATION
8589320 P.01i02
�lit�;LLVC 1/1/Jb
�•l �� �
LNING AREA:
GARAGE AREA:
DECK AREA:
OTSER•
�_Tel. �i �� �. � i���f
MIv LICENSE �_��1Z.�i. �
�r�i. � ,�,,J � �f � � ��
Attach co this application, a Coitificate c�f Survey of t�
loc, with the pmposed constiuctioa drawn on it to scale.
Y�ESC�YQN 4F IDII�ROYEMENT
� __, Width Height --^, S4. Ft. —
�$�h = Width _ I�eight _ Sq. �t.
�$� Width � Hgt/Ground Sq. Ft.
Lc��� � � � � ��
Consuuction Type• � -�-� � ` �stimat� Cost: $ •�°— � �'Cj �, � v
(Fee Schedu2e on Back)
Driveway Gurb Cut Width Needed: _ Ft. + 6 Ft a_ Ft x$ -$
� �- ,
. " -�;
Per�mit Fee
Fire Surcharge
State Surcharge
SAC Charge
Licease Surchargc
Driveway Escrow
Erosion Con�oi
Park Fee
Sewer Main Charge
roTar.
STIP'ZJLoATIONS:
$ S �� 2 S�
$ /. �
$ , o
$
$ � Gc�
$
$
$
$
� ��� 5��
Fee Scheduk on Reverse Side
.001 of Permit Valuation (lllOth�)
$.50/$I,OOQ Vaiwuioa
Tel. �t � � -"���
$100D per SAC Unit
$S.� (State Lic�ns�d Residcntial Contractors)
Ali. 'A" c�r Alt. "B" Above
$450•00 Conservacion Plan Reriew
Fee Detennia� by Engi�ering
Agreement N�► [ ) Not Necessary [ ]
Building
Inspections
763-572-3604
763-502-4977 FAX
BUILDING
�
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-08
DATE YOUR E-MAIL ADDRESS
srrEaDDxESS , 6710 Channel Road Fridley, MN 55432
THIS APPLICANT IS: �OP/NER ❑CONTRACTOR
PROPERTY OWNER/
TENANT
Ed Holland
6710 Ch�anr
pxox�: 763-571-7214
CONTRACTOR ADDRESS:
SUBMIT A COPY OF pHn�
YOUR STATE LICENSE
STATE LICENSE #
PROPERTY TYPE IXSINGLE FAMILY/NEW CONSTRUCTION
❑'I'WO FAMILY/NEW CONSTRUCTION
PERMTT TYPE
❑ EtASEMENf FINISH
❑ I)ECK
TYPE OF WORK: ❑ DIEW HOME CONSTRUCI'ION
❑ A�LAINTENANCE/REl'AIIZ
DESCRIBE WORK BEING DONE:
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENINGS ❑Yes m10
OR FOR NEW OPENINGS-DESCRIHE SIZE OF
OPENING CHANGES &
TYPE OF WIND{�W TO BE IIVSTALI.ED
Permit N
Received By: .
Date Rec'd: � I � I ��
CITY Fridley STATE�ZIP 55432
�-' �C�s���a'°'���N
CTfY
FAX
EXP DATE
SIZE
STORIES
❑ ROOF . ❑ DRAIN T1LE
❑ SIDING ❑ OTHER
❑ SWIMMING POOL
O REMODELING
17'
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACf�ED GARAGE
HEIGHT
ATE ZIP
�
BASEMENT REMODELING SUBMIT:
I. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTI2UCTION INCLUDING DECKS,
❑Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Trim 1. Site Plan/Survey showing the existing structures
� Fascia and proposed project.
2. Two sets of construction plans
3. Energy Calculations
LOCATION OF WINDOWS
NUMBER OF
ALL FEES ARE BASED ON VALUATION, INCLUDING 'THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION $ �� �—]N�cQ ��1997 UBC FEE SCHE OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcha.rge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
� ��c `_1e�1—
$ � °-� o �
$ �
$
$
$
$
$ f
$ �� �s �
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1825 per SAC Unit (Plans to MWCC for determination)
ft+6�t= ftx$21 =$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary (
Make checks pavable to: City of Fridlev
IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
Attach
I hereby apply for a bui ermit an�i I acknowiedge that the informa6on above is complete and accurate; that the work will be in wnformance with the ordinances and codes
of the City of Fridley and wi e Minnesota Cons ction des; that I understand this is not a permit but only an application for a permit and work is not to start without a
permit on site; that the work will in nccord ith th a, roved lan i e case of all work which requires review and approval of plans.
SIGNATURE OF APPLICt� T PRINT NAME FDA//� �I�Q`�ist�f//% DATE ��
. . . . � � : ��%��'i(�'�11`���;'GI.L� � .
Page 2- Building l�esiden?tial Application
BUILDING 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:
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
a11ow for proper review of proposed structure and of the construction site.
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
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432 '
763-572-3604
Faz: 763-502-4977
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