AF - 37004City of Fridley, Minn.
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N° '�99�
_ BUILDIliTG P�RMIT ��'� s ���
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owner: Rolana 1�Ia.e�n.e B�� �iFaSTRCCH BuILDE� 560-652�
� 673�t Channel 1�oad �. E. A�
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LOCATION OF BUILDING
No. � Siseet ��T�el RoBd Id. E. Part of Lot I�1o. � ft.
Lot �' Block Addition or Sub-DivIsian BTOOkVieW
Coraer Lot In�de Lot g Setback Sfdeyard
Sewer IIevatlam Fo�mdaafiton IIevat[on
To be vsed as:
DESCRIPTION OF BUILDING
Front Depth Height Sq. Ft Cu. Ft
FYont Depth fTeight �.1. Ft C�. Ft
Type of Constructfon FP�tne F°at. Cost �19 .000� .0� To be Completed
�._ ��
Ea consideration of the 9sauaaoe to me of a permit to construct the buildiug described ab�ve agree to
the proposed work fn acoordance with the d�scription abare set forih, and 9n com wi p�Q�a
ordiIIBIIt�s oP the dty oP Fridley. .,f.�' � C_._..�- -"" '(„ �' ,.//'
In cam�deratloa oP the �yment of a fee oP $�L . permit 9s herebY �an�
to construct the building or addition as d�cribed above. This t fs grant¢ci upon
t�e express condition that the peraon to whom it is �anted ead his agents, employ►e� an worl�en, ffi all work
doae in. around and upon said huilding, or anypart thereoP� shall conform in aII reapects to the orAfnances of
Fridley, Minnesota g la�tton� a�natruct�fon, alteratton, maintenance. repafr and mov9a� of bufldinge
within the dty l9mits�thia permft may be revoked at a�► ti�ne upoa vYolation of a:p► oE the P�via�lana oP said
orrlinances.
Allen Jensea � ��
NOTIC�
11ds p�emit doa nof eeru Ha ee�hasrlae, lo�al�loe fer 'rirleY. P�9► Ya� 6eadna, srwu m rr�ter. B� sar� to a�
th� BQi�ieB losputor ior ppnal� p�tfs Ior f6�» It�nn.
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APPLTCATI�N FOR BUILDYI�C !'uJ'�►�1IT / �� �� �
CITY OF F';3IDLEY, 1K�NESG+A
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.,, �' �� 7` r, LOCATION OF ILDING
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No. ' Street �E! � s Part of Lot���� �.
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Lot_ �s,�l Block �' Addition or Subd3visi.czn �►� � � -� � � ^^ � ��
Corner Lot Inside Lot' "��` Setback � „�� �-> Side-Yard �� �° /j � °
SEWER ELEVATIQN FOUNDATION II,EVATION
Applicaat atCach to this form Two Certi�icates of Survey of Lot and proposed build-
ing location drawn on theae Certificatea.
To be used as:
DESCRIPTION OF BUILDIP'G
�� Froat '� � i��ch Height � �
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Sq. Ft . � Cg C� Cu . Ft . '� �ti , / �� �
Froat Depth � Height
Sq. Ft. Cu. Ft.
Type of Conseruction y�„���,�_,,� Estimated Cost �/� f� --•-�� ''
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9'� � � I . - . ' ,�
To be Completed
The undersigned hereby ma�kes applicat3on for a permit.for the work herein specitied,
agrpeing to do all work in strict accordance with the City of Fridley Ordina;�ces and
rulin.gs of the DepartmenC of Buildings, and herebq declares that all the facts 8ad �
represeatations at ted in this application are true aad correct. � '
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DATE � � �,�' ° �
�Schedule of Fee Costs can be found on the Reverse Side).
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BUII.DING PEZ' �;T FEL� S�'lEDULE
5ectioa 2. The Inspector of Suilditi�s shail; before iasui�g any pea�it for
the erection of any building ar etructure, o; for aay addition to an� e:-�et-
ing building or structure, or for �ay alteraCions or rep�1.�� Co any existing
build3ng or seructure, upon applicaCion therefor, require the pay�aeat �y the
applicant for such permit of �ee� to the amount hereia below set foreh ac�d
ia the manaer herein provided to-witt
2.1. Fos any such permit for the erection o,f ariy fire-proof building, �ther
than a garage� warehouae, factory or gr�in c.levator, cr for the erect�on of
ariy fire-psoof addition, for similar occupancq, to anq existing buildi��
shall be at the rate of $1.40.for each one thousand cubic feet. os frac�3on
thereof. in such cubical doatents. `
2.2. For any suth-permit for the erection of any fire-groof garage, warehouse,_
factory or grain elevatot, or for the erection of aay fire-proaf aslditio�,
for similar occugancy, to any existing build3tag-sh�ll be at the rate of $1.25
for each one thousand cubic feet� classified as °1fireproof" by Section 5C2 of
the Mianeapnlis 8uildiag Code.
$OUSES .
2.3. For any auch permit for the erection of eay.non-fireproof build3r..� o�:hes
thaa a garage, warehouse, factory or grain elevator, or aaq non-fire�rccY�
� additiloa, fer.eimilar occupancq, to any enisting building - permit $�.�0 �or
^ each one thousand cubic feet.
GARAGES
2„ .4� For aay such permit for Che erecs:� �,� n � ar;: r�oa-£i vA���o� gara�e, .
warehouae, Factory or grain elevator, r•_� � c,�;, ►.=zr ,T�Frr,riora o:� any non-t�Lregroof
additiaa, £or �e3milar. occupancy, to r.-;,y ,�t::t� :��,�,� �;�j,;;��,�,o o� for each aLCh
buildiag or addit3on - ninety ce*��� P;; ;�, ai'd a.^� er.=�:, oae Chousand c�abi� feet
or fraction thereof, in the cut �.c�l r:��.� �r.�:� .t��er�es with a minimum of $4.Q0.-
For the purpose of camgut�i.ag fees f�� 'uu:L �.c�ing permiE:s, the cubical coate�ta
of eay building or additiea to a unifc�.� taei�iit throLghout by multiplying the
ground area covered from a point s3g (6) 3achea be?�w the floor line of.xhe
basement or cellar �to the average height of C�p ��per surface or to the �
avera�e heighC of the roof surface of the main �able o£ a pitched roof.
2.5. For repairs or alteratione to an exiatia� structure, the �ee ahall be
at the rate of $3.00 per each Five Huadred Dollare ($500.00) os fraction
thereof in the co$t of all proposed work.
2.6. In no case shall the fee.;charged for.$nq permi� e� set forth ia
.Section 2 be lesa thaa $4.00.
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sue�ecr P E .
City of Fridley � � . �
AT THE TOP OF TNE TWINS g U I L D I N G P E R M I T �° ���
r
� �' COMMUNITY DEVELOPMENT OIV. RECEIPT NO
' �1: -____-� �l
r � � PROTECTIVE INSPECTION SEC. I�
1 ; �
� � /"'1 � CITY HALL FRIDLEV 55432 NUMBER REV DATE PAGE OF APPROVED BY
�'""� � �'' 612-571-3450 9t0-F15 11/12/96 / /
10B ADDRESS 6734 Channel Road NE
i LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2(F Brookview Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Roland Ma.gne 6734 Channel Road NE 571-0112
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO
Cities Home Im rovement 6148 Olson Memorial H, Golden Valle 55422. 20043502
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDFiESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION [�, ALTERATION O REPAIR ❑ MOVE O REMOVE
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8 DESCRIBE WOfiK
Reside & install soffits
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CEFiT4FV 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 OFiDINANCES GOVERNING THIS TYPE OF WOfiK WIIL BE COMPLIED @ @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �yC �OOO �p3.00
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL TH� pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCT N OR THE PERFO NCE OF CONSTRUCTION �LLL.ZS Fire SC �C).00
PLAN CHECK FEE TOTAL FEE
� � � l6 License SC $5. $126.25
SIGNATUAEOFCON'RACTOAORAUTHOAIZEDAGENT IDATEI WHEN PROPER Aj,�DATED THIS IS VOUR PERMIT
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S�GNATURE OF OWNER �iF pWNER BUILDER� IDATEi , ^� Bl �NSP qpiE
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NEW
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress: ��,� ' � � ,� �' C'` � �, � � ��
Legal Description:
Owner Name & Address:
Contractor:
Effective 3/1/96
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Tel. 1# ��%—G//�
MN LICENSE #
Address:�% �' �i' � �rch �.� �c� u v
� � � Tel. # �l G�3 >
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Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IlVIPRO���NT
Length Width • Height Sq. Ft.
�ng� Width Height Sq. Ft.
Leng�th Width Hgt/Ground Sq. Ft.
Corner Lot [] Inside Lot [ J Ft: Yd Setback -: � Side Yard Setbacks
' � ' f.� ;y�'.'� � Estimated Cost: $�� ° �
Type of Construction. ��tC,
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Approx. Completion Date: � �;: �b . -
(Cos�t~ on Back)
Driveway Curb C�t Width Ne�eded: Ft. + 6 Ft = Ft x$ _$
DATE:
Permit Fee
Fire Surcharge
S��C $UrCllalge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
APPLICANT:
C1TY USE � ONLY •
Tel. #
$ �� z�, Fee Schedule on Reverse Side
$ , � .001 of Permit Valua.tion (1/lOth%)
� � �.J�O�$1,�� �!�Us1ilOII �
$ $900 per SAC Unit
$ �= � $5.00 (Sta.te Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
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BUII,DING 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 alteration or repair to any existing building or
stnicture, 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 tawit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
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,�0 plus $12.50 for each additional $1,000
or fiaction thereof, to and including $25,000
=, . �: $25,�1 to $50,00(� • . � . � . ' �349.75:for first:$25,UOb �lus•$9.��for eaeh• adclitional$1;fl0(?' .. : • .• ' .
' • � � ' or fraction thereof, to and including $50,�0 � � . ' �
$50,(?Ol to $100,000
�100,001 to $SUD,000 � : .:��
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$500,001 to $1,0�,�0 �
$574.75 for first $50,000 plus $6.25 foP each additional
$1,�?0 or fraction thereof, to and including $1�,000 .
$887:25 for first $100,0(m► plus $5.� for each additional .
$1,0� o.r. fraction.ther�f,vto.and.�nciuding.$500,000 .
� ,, _ _
$2887.25 for�the first $5�,� plus� $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,�1 and up $5012.25 for the first $1,000,� plus $2.75 for each, additional
$1,� or' fra�lion` thereof - .
; , : , DRiVEWAY'DEPRESSION ESCROW . -
(Concrete C�rb Streets Only) :
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.�.
Alternaxe "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 proger
review of the proposed structure and of the construcdon 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 procesding with the framing.
.._
sue�ecr ERMIT NO.
City of Fridley ;� � � '; 0
AT THE TOP OF THE TWINS g U l L D I N G P E R M I T �
r
; � REC O.
� ` COMMUNITY DEVELOPMENT DIV
r � ~ � PROTECTIVE INSPECTION SEC ���
� �
' � �'��1 � CITY HALL FRIDLE� 55432 NUMBER AEV DATE PAGE Of APPROVED BY
�""� � �'J 612-571-3450 9t0-F15 6/24/97 / �
JOB ADDRESS 6734 Channel Road
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. LQ� Z�F Brookview Addition SHEET
2 PROPEHTV OWNER MAIL ADDRESS IIP PHONE
Ro11ie Ma.yne, 6734 Channel Road, Fridley, MN 55432
3 CONTRACTOR MAILADDRESS Z�P PHONE UCENSENO
Ives Enterprises, 2945 - 140th Ave N.E., Aam Lake, MN 55304-0000767-4963 6478
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW �1 ADDITION ❑ ALTERATION O REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Deck Construction (10' x 13'6")
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY IOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, NEATING,
VENTILATING OF; AIR CONDITIONING.
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 COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED THIS APPLICATION STA�LS GAFAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUFTAX
AND OFDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �2 �OOO �. GI
WITH WHETHER SPECfFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEqp�1T FEE SAC CHARGE
P VISIONS OF ANY O HER ST E OR LOCAL LAW REGULATING coN- $43. OO ire SC � 1. Z1
S RUCT N THE R OF CONSTRUCTION.
�af PLAN CHECK FEE TOTAL FEE
�'c� License $5.00 $49.82
si� A UAEOFCON'RACTOAOR RiZEDAGENT �oAT � WHEN PFiOPE VA IDATED THIS IS Y UR PERMIT
_ � � �:� �=��-�
SiGNaTUREOFOWNER�iFOWNERBUILDE � �OATE� B G�NSP ���TE
NEW [ ]
ADDN [ )
ALTER [ ]
ConstructionAddress: � �
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
,
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Owner Name & Address: � LL(� ���� - Tel. #
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Contractor:
Address:
Effective 1/1/97
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32e� �/Yj
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MN LICENSE # _ 6� g
✓��Tel. #
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Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIP'rION OF IlVIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length . Width Height Sq. Ft.
DECK AREA: Length �� Width �� Hgt/Ground� � Sq. Ft. 3�� g7
OTHER: _ I I���
e
Construction Type: 1��'1� j�6�� ��a� Cost: $ �. �U
(Fee Schedule on Back)
Driveway Curb Cut Width Nceded: Ft. + 6 Ft = Ft x$ _$
DATE:
� � �— �% APPLICANT: / I' � l l ��� L �� �� Tel. # � �� �-�
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CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� L�
$ , �
$ , /
$
$_'sG�
$
$
$
$
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Fee Schedule on Reverse Side
.(HIl of Permit Valua.tion (1/lOth%
$.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 []
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(iUlLD[NG PERM[T FEE SCHEDL'Lt�:
`I'(ic Chief Building Officia( shall, before issuing permits for the erection of any building or structure, or fc�r
any •addition to any e�isting building or structure, or for any alteration or repair to any existing buildinv 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 $SQO
$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,OQ0,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for fust $5� 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,(�0
or fraction thereof, to and including �25,000
$349.75 for fust $25,000 plus $9.00 for each additional $1,0�
or fraction thereof, to and including �50,000
$574.75 for fust $SO,Q00 plus $6.25 for each additional
$1,Q00 or fraction thereof, to and including $1p0;000
$887.25 for first $100,000 plus $5.00 for each additional
$1,DQO�or fraction thereof, _to and inciuding $5�,{�00
$2887.�5 for the first $500,000 plus .$4:25 for each add.itional
$1,� or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,(300,000 plus $2.75 for each additional
$1,� or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
d`�lternate "A": Removal.and replacement of curb and gutter only = Driveway width plus 6 feet times $13.�0.
:�lternate "B": Removal and replac�ment 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 FO[Jl\TDATIOti'
�'�rnlits for construction witl be �ssued a minimum of 24 hours from the time of application to allow ior proper
:����iew of the proposed structure and of the construction site.
'� Certif icate of Survey of the lot, sho«�ing the tocation of the foundation ��nce it has it has been c�nstruc' _• :
�i;i h� required i�ct�c�re E�r�,��c;din�� «�ith the framir�,.
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� Q Footings wilf be 42" deep, 12" diameter
• Structure wifl be 2 x 10 GT �y'� G'. �•
• Decking will be cedar
• Rail height 36" min.
• Rail space 4' max.
• Step�un��ll be 9" min
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• Posts will be 6 x 6
` O��hy s� .
SUBJECT
c�ty of Fridley
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
i �
� �
� ' COMMUNITY DEVELOPMENT OIV.
� � �: ------�
r � � PROTECTIVE INSPECTION SEC.
1 . �
i--_.� �"' �,� CITY HALL FRIDLEV $$432 NuMBER
t 612-571-3460 9�0-F15
JOB ADDRESS
6734 Channel Road NE
t LEGAL LOT NO. 9LOCK TRACT OF; ADDITION
DESCR. 2G, Brookview A
2 PFOPERTY OWNER MAIL AODRESS
3 CONTRACTOR MAIL ADDRESS
Four Seasons Roofing & Remodeline
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAILADDRESS
8 USE OF BUILDIN(i
Residential
7 CLASS OF WORK
REV OATE PAGE OF
8/17/98 / /
�PE�ifdflT NO.
27229
�ti'F�I NU.
,�`a3�
APPROVEO BV
SEE ATTACNED
SHEET
21P PFIONE
571-0112
21P PHONE LICENSE NO.
aiP� 7A5—Abl(1
21P PNONE LICENSE NO.
ZIP PHONE LICENSE NO.
O NEW ❑ ADDITION O ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage (24 Sq) Tear-off
9 CHAN(3E OF USE
TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING. �"`�• ��
VENTI�ATING OR AIR CONOITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WOHK IS SUSPENDED OR ABANDONED FOFi A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG.
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION
ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION
AND ORDINANCES GOVERNING THIS TYPE Of WORK WILL BE COMPLIED
WITH WHETHER SP IFIED HEREIN OR NOT. TNE GRANTING OF A PERMIT �ZOOL
DOES NOT PRESU TO GIVE RITV TO VIOLATE OR CANCEL THE pERMITFEE
PROVISIONS OF Y OTHE STATE R LOCAL LAW REGULATING CON-
STRUCTION OFi E PERFO ANC OF CONSTRUCTION. �%4. ]S
�yP / � ('i PIAN CNEC
� �% License
Si ATUREOFCONiRACTOR RAUTMOR12EDAGENT iDATEi
S�GNATURE OF OWNEF��F OWNER BUILDER� IDATEi e�
SO.
STALLS
5.00
GHOUP OCCUPANCVLOAD
CU. FT.
OFfSTREET PARKING
IGARAGES
�1.��
SAC CHARGE
Fire SC $2.00
TOTALFEE
$82�
IT
� � ! � 7
, _. , �
.---�='� [ ]
-' '_ _:'c [ J
'>c:structionAddress:
. ..i ! iescription:
�CITY OF FRIDLEY
SINGLE FAMILY•AND D���LEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
� /��7� � Y���
„_._: Narnc. '� Address:
`; , i
�
Effective 1/1/98
0'� �
:� �
� a..
�� .�
Te�. #,,e�'. `�I —� l l �L,.
_._.....:tur: �,�� r S-e��s I���o�'ci� �.������� ��;,� a LC.C: _MN LICENSE #_
_ . . . � �5 : ' ,� �°?%.i C�f�I ! U' 2.r5 t -�4 �2. /ii'f �r t � (-�j Tel. # ��� ��l �
�
Attach. to this applicadon, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
I3ESCItIPTION OF IMPROVEMENT
__; u r;.��:. � a Length ' ' Width Height Sq. Ft.
_. _. _.��i+: �:�:t�,: Length ' �Width Height Sq. Ft.
J��i� ���: �� Wi�th Hgt/Ground Sq. Ft.
� /� _ � �, > � � ��1 �' /A _ � j
�.;':' �i��2:
�
� � �� � r
:�:.;:1-�:��rai� 1ype: Estimated Cost: $
(Fee Schedul e on Back) �
:,.„.,�� C��rb t�ut Width Needed: Ft. + 6 Ft Ft � __$
;
� � _,i, :.': �� `�� AIPPLICANT: r�"�� � � �' Tel. ��`�
CITY USE ONLY
,_.,_.. �:;;;;, �; �L/ %� Fee Schedule on Reverse Side
.. ,...._ �h�r�Se � � D D .OU1 of Permit Valuation (1/lOth%)
,....: �archarge $ /, D D $.50/$1,000 Valuation
:��C Charge $ $10(10 per,SAC Unit �
T icense Surcharge $ �. (�(� $5.00 (State Licensed Residendal Contractors)
_; r: . ��,, :�y Escrow $� Alt. "A" or Alt. "B" Above
::-osion Control
�-., _;e�
� _ „ :: tviain Charge
�rc� r�.
. :'! �' ULATIONS:
$ ,$450.00 Conservadon Plan Review
$ Fee Determined by Engineering
$ � Agreement Necessary [ ] Not Necessary [ ]
�
$ 8�- 7�
_ . -�
BUII.DING PERMIT FEE SCHEDULE
'i'he Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
::��y addition to, any exisdng building or structure, or for any alteration or repair to any existing building or
�� ructure, upon application therefore. require the payment by the applicant for such permit of fees to the amount
���rein belo`v set forth and in the manner herein provided to-wit:
i'GTAL VALUE
:' cu $�00
. ��:;1 to �'�,Q00
:::,GO1 to $25,000
�.': � >U01 to �50,000
;�O,GO1 to $100,000 .
;�_:i�,�;il :o ��QO,OG�
�,::vU,0U1 t� �1,000,000
y 1, OOa, 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 $25,400 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 $1�,000
$887.25 for first $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 ar fraction thereof, to and including $1,000,000
$5012:25 for the first $1,000,000 plus $2.75 for each additional
$1,OQ0 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
:�lteniate "P►": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
,�Icernat� "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 .
r'ermits for construction will be issu�d a-minimiun of 24 hours from the time of application to allow for proper
:���i��i� of the proposed structure and of the construction site.
y Ceniiicate of Survey of the lot� showing the location of the foundation once it has it has been constructed
�vill be required before proceeding with the framing.
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
PE N0.:2004-011ll
DATE ISSUED: 07/14/2004
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 6734 CHANNEL RD NE
PIN : 133024210048
LEGAL DESC : UNAVAILABLE
: LOT BLOCK
PERMIT TYPE : BUII,DING
PROPERTY TYPE : RESIDENTIAL
CON5TRUCTION TYPE : ADDITION/ALTERATION
VALUATION : $ 4,087.00
NOTE: SEE NOTATIONS ON PLAN.
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTII.,ITY LQCATIONS.
PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF TI� DWELLING PER R317 OF TI-IE
2000 INTERNATIONAL RESIDENTIAL CODE. BATHROOM REMODEL.
STATE LICENSED CONTRACTOR 1
APPLICANT BUII.,DING PERMIT FEE 111.25
LOYAL HOME IlVIPROVEMENTS (20353848) PLAN CHECK �EE 72.31
477 GRAND AVE FIRE SURCHARGE 4.09
ST PAUL, MN 55102 STATE SURCHARGE, VALUE 2.04
LICEN5E 5URCHARGE 5.00
TOTAL 194.69
PAID WITH CHECK # 2010
OWNER
MAGNE ROLAND J& RUBY K
6734 CHANNEL RD NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This pemut becomes null and void if work or construction
authorized is not commenced witin 60 days or if consttuction
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 work
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or 1 the provisio of any other state or local law
regula ' co ction th o of cons c o.
Ap lic � v t'�.Date
.
Bldg Ins Dat� �
SEPARATE PERMITS REQUIItED FOR WORK OTI-IER THAN DESCRIBED ABOVE.
_�, JUL-43b-�d 14: 44 FTI�i �: I TY 1� FR I IN�Y
TD ��.�f� �G�t74iS�i F.�i2/�i4
p,lEV1/ ( ] C17Y (� �i�dOL�Y � " �J1/QOt'�6
A�I�N [ j �1 tJniv�rsikyy �v� NE. Er�y, MN 5�3� 47�3} s7 �tdg t�
ALTER (] 5t�t� � 1t At+tp p� h-1 � R Z �i�) 5�� 1�'i �a�c
�lJlLD1R1G PERAAIT APP�t�iTtOR!
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��'��� �'HIS J08 GOPY SHALL �E
�yA,lABLE ON 7HE JOB
SBTE FOR THE FRAMlNG
��`� �t��L INSPECTIONS
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ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
.--��. �
CI1'Y OF FRIDLEY PERNIIT N.: 2004-01346 �'`�
6431 iTNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 08/16/2004
(7631572-3604 FAX: (763) 571-1287
: 6734 CHANNEL RD NE
: 133024210048
: UNAVAII,ABLE
: LOT BLOCK
: PLUMBING
: RESIDENTIAL
: ADDITION/ALTERATION
VALUATION : $ 650.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A INSTALL ONE BATH TUB.
# ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0
# NEW FIXTURES (EXIST OPENII�TGS)
# GAS DRYERS
# OF NEW FIXTURES
# WATER TRMT APPLIANCES
APPLICANT
WELD & SONS PLUMBING
615 JUNEAU LN
PLYMOUTH, NIN 55447
OWNER
MAGNE ROLAND J& RUBY K
6734 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 consiruction
or work is suspended or abandoned for a period of 120 da.ys
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 pe rmance f construction.
Applicant � � � Date i
I: � _ i ���.����/� � , r:.f��:
0 # GAS WATER HEATERS
0 # GAS RANGES
1
0
VALUE (FOR 1�IINIMUM CALC)
PLBG PERMIT NIIl�TIMUM FEE
PLBG FIXTURES (NEW OPENIlVGS)
PLBG FIXTURES (EXIST OPENINGS)
WATER TREATMENT APPLIANCE
WATER HEATER - ELEC
WATER HEATER - GAS
GAS RANGE FEE
GAS DRYER FEE
PLBG REPAIR/ALTERATIONS
STATE SURCHARGE, PLBG FLAT
TOTAL
PAID WITH CHECK # 5370
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0
0
650
15.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.50
15.50
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A
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When realacin4 an existina furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plastic/PVC and meets all current codes and manufacturer
spec�cations including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's spec'rfications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existina combustion ai� is sized and installed to meet the cuRent codes
and ma��tfactuier's speeificatic�rs.
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes ( ) No ( )
Yes ( ) Ne { )
Yes ( ) No ( )
When installina a new ventina svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specfications. This does include AGA GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes.
No ( )
Yes ( ) No ( )
Appliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliancs #3 Type BTU Input Fan Assisted or Nat
Total Appliances Tatal Btu Input
Carn�on Vent Type -- - Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS• (Describe)
HEATING CO:
Signed By: Date :
Building MFCHANICAL PermitNo.: ,, ����,���
Inspections RESIDENTIAL APPLICATION Received By:�_ ,
7. 63-572-3604 CITY OF FRIDLEY Date Rec'd: '�-�`� °`� �
DA'fE � � d YOUR E-MAIL ADDRESS
S1'CE ADDRESS
THiS APPLiCANT IS: O OWNER �°CONTRACTOR
PROPERTY Nplv�:__�i 6/i,��,1y1. �h/
OWNER/ pDDRESS:���l� �/ i:.n.,i./ IAn� ��i CITY 7'✓.�,/�� STATFs��,�/LIPi��N
TENANT ° �'�°�—
PHONE;�/D .�'' � �7/ - �r/,�!,3
CONTRACTOR coivrnnx�r NaME:
SUBMIT A COPY OF �NTACT PERSON: ��� / /il�' :�f "��I U
YOUR STATE STATE LICENSE # EXP DATE ,
LICENSE WITH ADDRESS:����%���1�� �i.,� l9i� CITY���j�c,� STATE�,ZI�S`'a3�"'1
APPLICATION pHONE � FAX
,
PERNIIT TYPE �GLE FAMILY 0 TWO FAMILY O TOWNHOUSE
TYPE OF WORK: ��W ���CENI�TTT ❑ ALTERA'!'ION/REMODEL
DETAILED DESCRIPTION OF WORK
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of t6e 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 labor )
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 WHERE NOTED. FiXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOV�
Equipment Installed . MFG: MODEL: SIZF/BTU
IvIFG: MODEL: SIZE/BTU
MFG: MODEL: SIZF/BTU
_A/C $25.00 FIREPLACE (GAS) S15.Q0 GAS RANGFJOYEN $10.00
AIR TO AIR EXCHANGEER $15 _FIREPLACE (W�D) $35.00 • NEW GAS GRII,L $10.00
_BOILER $35.OD _FURNACE $35.00 _GAS UM'I' H1R $10.00
CHIMNEY LINER $10.00 . _GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VEIJTILATOR $15.00
�����ut������,_ r.: °. � °�o� �i��R��.�oa.�,,�s� �������.,��.�� �'����" ,.b : � c�� ��j x. � , �ry%�
°'� . 4„�. K:..�'.�+�'�� ,6Q' ���V.57^'
Permit Fee $ �_. , Number of fixtures @ $10.00 x $10.00 = $
Surcharge .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL Dil� $�. C Number of fixtures @$25.00 x$25.00 =$
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Tota1= $
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 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 rk which requires review and approval of plans.
SIGNA'lURE OF APPLICANT '� PRINT NAME ��.1 � c,,�DATE ?o�i'!i/ _
-`
, �� : � �!.`�E �V`�1,T�'�SE��A E�ERMITS�`ARE� � UIRE,D.,'FObYzBU�LDING�'E��C G��y,� ��,p�
��` .. ._.. ... a . ,.... �.. . , ,,t?�l.y;t?!������ .�.� :��_. . :. -
C�iy of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
f.
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMESIADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR
�
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below) .
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. NatUral Gas or PropanellFGC Chapter 3 with MN Amendments �
2. Make-up Air (See note below)
a, IMC Chapter 5 with MN Amendments , -
3. Ven.ting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUtRED FOR NEW HOMES
4. Heat loss & cooling load per room
a., Ftequired on new constructiqn IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
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N01'E: Centerpoi�nt Energy Mechanical Code Guidelines software may be used for
combustion and make up air calcula.tions