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City of Fridley, Minn_
BUILDING PE�T
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LOCATION ING
No. !�����SLreet � Part of I.ot _
Lot ��— _ Block � Addition or Sub� o���-�-���� °�r �-�'
Coraer Lot Inside Lot �ttback '� Sideyard _.
Sewer IIevation Fo dation IIevat4on
DESCRIPTION OF BUILDING • .
To : U ��
Front � Depth .� Height .��_ Sq. F`t. .���� Cu. Ft �
4
- Fron Depth __ �` eight �._..._ Sq. Ft Cu, F� Y..
Type of Construction �� Es�. Coat � '}�" ••�_ To lx Completed
In coneiderat�on oP the iasuance to me of a permit to consLruct the building descxibed above, I agree to, do
the proposed work in accordauce with the description above set forth and in' compliance with all provisions of
ordinanoea of the dty of Fridley.
c�
In consideral3on oP the payment of a fee of $"�_�� , permit fs hereby granted to
to construct tb.e building or addition as describ� above. This permit ie granted upon
e express condition that the person to whom it is giaated and his agents, employees and workmen, in all work
done in, around and upon said building, or any part 'thereo�, shall cronform 3n all respects to the ordinances of
k'ritIIey, 11?3nnesota regar8in� local3on, construction, alteration, maintenance, repair and moving of buildings
o��� dty limits and thie permiY may be revoked at any�' ��violation�of any oY the provisiona oE sa3d
Suildiag inapector
NOTICE: , -
Thfs p4rmh does nof eevee the coeatruetioa, installatton for wtrina, plumb6�g, eas healieg, sewer or wafer. Be sure fo see
the Buildteg lespeetor for aeparate permlfs for t6ese hems.
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APPLICATION FOR B[1ILDING PER1�T
CITY OF FBIDLEY, MINNESaTA
Owner's Neme Builder
Address Address
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Lot Eiock Addition or Subdivision
Corner Lot �„_ Ineide Lot ��#back
SEGIBR SLEVATiON
� �
Side Yard�
EI,EVATION
Applicant attach zo this form Z'wo Certificatea of Survey of Lot and proposed
building latation drawn on thes� Certificates.
DESCRIPTION OF BUII�DING
To u ed as:
Front DepCh�%�—�---Height � � _ _
Sq. Ft. Cu. Ft. �� �e1�o
Front Depth Seight
Sq. Fk� Cu. Ft.
, �
Tyge of Canatructioa Eetimated Cost
�o be Completed
9.'he undersigned herebq makes application for a permit for the wark herein
specified, a�reeing to do all work in strict accordance with the City of
Fridley Ordinances and ruliags of the Department of Buildin�s, and hereby
declares that all the facta and representations stated in this applicetioa
are erue and correct.
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(Schedule of F�e Coets can be fouad on
e 3ide).
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BUII.D�NG PExNQT FEE SCHEDULE
Sertion 2. The Inspector of Buildings,shall;�befcara i,$suing any permit for
the erection of any building or structure, or Eor auy addi�ion to any exist-
ing building or structure,..or for any alterations dr repairs to any exiating
building or sicructure, upon application therefor, require the paymea� by the
applicant for such permit of fees to the amount herein below set forth and
in the manner hereia provided to-wit: �•
2.1. Eor any such perm3t for �he erectioa of any fire-proof building, other � �
t�an a ga�age�, warehouse, factory or grain elevatior, or for the erectioa of
any fire-proo� addiCion� for similar occupaacy, to aRy existing buildiag
shall be at the rate of $Z.40 for each une thousand cubic feet, or fractioa
e�hereof, in such cubical contenta.
2.2. For�any such permit for �he erection of any fi;e-proof �aragef warehouae,
faetory or gra�tn elevator, or for the erection of any fire-proof addition,
for s�milar occupaacy, to any exieting building shall be at the rate of.$1.25
for ea�ch one thousand cubic feet, clasaif3ed as °1fireproof" by Section 502 of
the Minneapolis Building Code. ._ .
EOUS�S
2.3. For any such permit for the erection of any non-fireproof buildiag other
than a garage, warehouae, factory or grain elevator, or anq non-fireproof
addition, for simiLar occup�acy, to any existing buildiag - permit $1.40 for �
each one thousand cubic feet.
GARAGES
2.4. For any su�h permit for the erection o� any aon-fireprvof garage,
warehouse, factory or gr.ain elevator, or for the erec�ion of aay non-fireproof
addition, for aimilar occupancy, to any e�istiag buildfng or for each such
building or addition - aiaety cents ($0.90) for each one thousand cubic feet
or fra-ction thereof, in the cubical.contents�therepf with a.minimum ef $4.00,
For the purpose of computing fee� for building perm�i..ts, the cubical coatents
of eny building or eddition to a uniform height thxoughout by multiplying tha
ground area covered fram a poiat aix (6) inchea below the fioor line of the
basement or cellar to the aver�ge height of the uppe� surface or to the
�averege height oE�the,roof surface,of the main gable of a pitched roof.
2.5. For repaira or alterationa to an exis�ing structure, the fee shall.be
at iche rate of $3.00 per each Fivz Hundred Dollara �$500.00) or fraction
thereo� ia the cost of all proposed work.
2,6. In no case ahall the fee charged�for any permft as set forth in
Section 2 be less thaa $4.00. �
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Mr . Jerry Burka
6810 Channei Road N. �.
I�ridley, Minnesota 55432
��� �����i�a� ��s�� �o� 5927 �
�Ma�, 29 1962
p��� a .� 681 � el �e� 1�• �.
����o � Detached G� arat�e_
LL#�L�g (�l.� D
"��� �f�fi�� �� �a�en ��o��� by �ra� ���� A������ ��� �h� ��i�
�t�ia� � ��� ��c�r� ��������. b�a��c1Y� ��� t��� r��� a� �r�at b��
��Sl���a A� y� 9�c�p e i�ti��i��� ���� �� ���,d �c�� � � �9��
����d ��� ��.� d��� i � � ��a� �
R�.e�A� �r�� i� ��n�h w���s �fl��.� ������ f� ����� �g t�i� ���
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SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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� `y _ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
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�� �"'1 � CITY HALL FRIDLEV 55432 NUMBER REV. oaTE
""� � ,�� 812-580-3450
910-F15 g� �
JOB ADDRESS bg10 Channel Road N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 22 Brookview Addition
2 PROPEFTY OWNER MAIL AODRESS
Mark Glader 6810 Channel Road N.E.
3 CONTRACTOR MAILADDRESS
same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAIL ADDRESS
PAGE OF
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- PJ-Na.<"s`�.
�333�
APPROVED BV
SEE ATTACHED
SHEET
Z�P PHONE LICENSE NO.
ZIP PHONE LICENSE NO.
ZIP PHONE LICENSE NO.
8 USE OF BUILDIN(3
residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION C� ALTERATION ❑ REPAIR ❑ MOVE 0 REMOVE
8 DESCRIBE WORK
finish the basement
9 CHANGE OF USE FROM
STI PU LATION S
TO
1. Check furnace code with heating inspector for walls near chimney
�EPERA.tE PER�Ma�S u REQ�Ut�Dw ��`Oii. �fRtN�„
H�A,'� �� �� � �o
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUM8ING, HEATING, '' r� v� vv�•�
VENTILATING OR AIR CONDITIOIdING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTAUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 80 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. U
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED q
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT •tOO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. %.'�jO
SIGNATUREOF�ONTRACTORORAUTHORIZ�AGENT �DATEI
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�°'�/ _✓y.���5; � � ,/�� - �:'� —
SIGNATURE OF OWNER IIF OWN�R BUILOERI IDATEI
&+ '
OCCUPANCY(3ROUP OCCUPANCYLOAD
SQ. FT. CU. FT.
OFFSTREET PARKING
STALLS IGARAGES
.50
SAC CHAR
TOTALFEE
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APPLICATION FOR RESIDENTIAL ALTERATION,
ADDITION, OR REPAIR BUILDING PERMIT
OWN�R' S NAME :,,��7 � I��'/i C�� c 2 BUILDER.:- -��.�1 �,
an�r.ESS : � n/a �,fi=�,+✓�e ��, � r� Ann�ss : �
NO • . % �/(� S TREET • C r',� `I .�J� � ��� /�
LOT : 2 Z BLOCK : /v Cs ADDITION : �� ,�� �> /';�1 / t v✓
CORNER LOT: INSIDE �OT: SETBACK: SIDEYARD:
Applicant attach to this form �ao Certificates of Su_� of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
�',,,isl� ,�s�: c,�9�'Front: Depth: Height:
Square Feet: Cubic Fee�:
Fxont• Depth• Height°
Square Feet; Cubic Feet:
Type of Construction: (s�/c; ��'J �� q��, Estima.ted Cost: $ y U U
To Be Completed: _ _�, _ / � � �
The undersigned hereby makes applicativn for a permit for the work herein
specified, agreeing to do all work in stxict aceordance with the City of
Fri.dley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representatioa�s stated in this application
are true and correct.
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DATE : �7 - %'=� - 7 l� S IGNATURE • �`�/ %��-�' "�� J � �' , � 'U��
(See Reverse Side For Additional Infonnation.)
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BUILDING P�RMIT FEL-' SCHEllULL
SECTION 2. The Inspector of Buildings shall, Uefore issuing permits for the
erection of any buildiiig or structure, or for any addition to any existing
building ox structure, or for any alteration or repairs to any existing
building or strv.cture, upon application therefore, require the paymen.t by the
applicant for such permit of fees to the amount herein below set foxth and in
the ma.nner herein provided to-wit:
�iEW CONSTRUC�IOI3: Sing�.e Family Homes and Garages: $9.00/1000 cubic feet
PLAN CHECK: 25 percent of building permit fee.
ADDITIONAL INFORI�9ATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the gxound area
covered from a point six (6) inches below the floor line of the basement
ox the cellar to the average heights of the upger surface or to the average.*
�height of the roof surface of the ma.in gable of a pitched xoof.
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For repairs or alterations to an exa:sting s�ructure, the fee shall be a.t the
rate of $3.00 per each five hundred doliars ($500.00} or fraction tiie�eoi in
the cost of a11 proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be
l�ss than $8.50.
V�RIFICATION OF FOUNDATION
NOTE: Pexmits for constxuction will be issued a minimum of 24 hours �rom the
ti.me of application, to allow 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 proceeding with the framing.
CERTIPICATE OF OCCUPANCY
Application for a CerCificate of Occupancy shall be mads ten (10) days prior
to the use or occupancy of any structure for �ahich a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
oi Occupancy has Ueen issued. �
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1. LOtATION OF Y[LL� �
County Name //
Township Name Township
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,�- STATE OF MINNESOTA DEPARTMENT OF NEALTH
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��� l�' as���n � �car�n
� MINNESOTA UNIQIIE WELL N0.
__, (leave blank if not known)
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Numerieal Street dress and City of liel
Interseetion �, � �- B �_
�,�v••ry
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Shor exatt lo ation of well
(in sectio 9rid rith "X"j
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er n No. Fraetten
E 4 y of y
or
u
ation or Dtstsn e fro Road
�'
�Y�.
Sketch �"p�3f rell locallon
�-- 1 ..i ls � ,
2._ ��FlTY�S NAN�_ Ma{11r�Address if differenL than_ _
property address indicated nbove
� �
HARONESS Of
3. FORNATIOH LOG COL�R FORMATION FR�M
If not known, indicate formation log from new well or nearby well.
4. YELL DEPTH (completed) Oate sealed
� �PL. � D _ � �� -/ /
5. ORILLING METH00 (if known)
� Cable tool 4� Reverse �Q Drlven 10[] Oug
2� Hoilow Rod 50 Air 8� Bored Il[]
30 Rotary 60 Jetted 90 Pouer Auger
6. OBSTRUCTIUNS
Well obstructe� Yes � No
ObstructTons removed�Yes ❑ No If obstructions cannot be
re�ved, contact MDH
before sealing.
7. USE
� Domestie 40 Monito�ing 80 Heat Loop
2� Irrigation 50 Pubiie 9� Industry
3[] Test Well 6� Munleipal 1� Coamercial
70 Air Conditioning 11[]
I 8. CA�NG� --- - - -
� Blaek 4� Threaded 7C1
2[� Galv. 50 Yelded
3� Plastic 6[] Stainless Steel
TO � in. to �r.°! ft.
in. to ft.
9. SCREEN
p seree�ea rett +rom7G rs. to7� rc.
(If known)
� Open Nole from _ ft. to _ ft.
10. STATIC WATER LEYEL
� � ft.� below � above
land surfaee Oate Meesured
11. WELLHEAD COMPLETI�N
1� Pitless Adapter 40 Found Buried
�esement Offset '�
30 Well Pit
REMARKS, ELEVATION, SOURCE OF �ATA - CASINGS RENOVED, CASINGS PERFORATED. ETC.
12. GROUTING INFORMATION
j�ij Neat CemenL 2(] BentoMte �
Grout materlal �from�_�to_d it. cu. yds_
FFICIAL ABAN00lIEO YELL RECORO (May be used for Property Transfer)
Z�Q2TaMl a PIIB i�ITB DBSD
13. NEAREST SOURCES OF CONTAMINAT(ON � �
�� feet �� directton �t�a�,. type
41e11 disinfeeted befare seeling7 [] Yes
14. PUMP � Removed � Not Present
Type: 1[1 Submerslble 3� L.S. Turbine � ReciprocatTng
F� Jet 4� Centrifugal 6�
15. EXISTING YELLS (Plesse sketch loeattons of abandoned and
aetive we11s in remarks sectlon or on back.)
Other unused rall(s) on property7 � Yes No
Abandoned: �] Permanent � T�porary � ot sealed
17. YATER WELL C�NTRACTORS CERTIFICATION
This well aes sealed under my jurisdietion and thls report
is true to the best of my knowledge and belief.
L1cen�� Bus�e� N������ Liceg���o.
��
•
Address ��.te� ..-aln `t- �
Signed � ?-" Oate / t7 ' �
F=' � fY1 I��� �L
.
�
�C3t� . i . F��i��.
� � I LJ,(�
� �"i 'f � +t ri ; �'- +�
/� �` 1 : ��L r��'"'
�r'�i: tt3 F! �,7�i r�L.aJS
i�I�� OF WATER WEL� 1�BANDON1��21TS
�ZISTED $ �CI�'Y� . �
THEN NO�ICALLY. BY ;ADDRE�S
FOR T�iE CIT3[ OI�
.
**� I�'RIDLEY **�
6431 UN3V�RSiTY AVE. NE.
B.I. MR. DARRE� C7�ARR 5 idIIi. DON �ARRIG�IN
574-3450
NO p�� FEE OR INSPBCTIQTii
� � ..' v f C'/ f '+. � .
�
,
•�. ��LER SIZ� OWNER—CON�'RACTOR SITE ADDRESS DAT$ S$AY,ED
`� t�
3't�RGERSON
�. H. RENNE�t
MO�K
�iORR
�l—WE3.T�
B.$. RBNNER
E.H. RENN$R
E. H. itSNNEit
TORG�RSON
�. H. REI�TI�
$. �. RENNffit
$.�. RBNNBR
8. H. RENriER
$.H. RENNFR
B.H. RENN$R
$.H. RSNN$R
E. H. REI�iNFR
E.S. RENNER
E.H. RBNN�R
DON STODOi.�I
MOitit �
r^�x
� %W3G
B. iI. it�NI�iER
1�
3
3
4.
1�
l�
1�
2�
3
1�
�
4
2
l�
1
�
.
BORDI�N
SHARON �1NDERSOl�i
ANORA CO. CO�. ,ACTION
ANORA CO. COMM. ACTION
EI.I,EN K1lRI
FRZDLEY SCH. DIST #14
D$BIE � DAVID TAYLOR
H�fRLIN S 1�1�iXINE 50ND
ROBffitT RNDDSON
LOIS HI.AVINRA
LOIS HLAVINR�
ONAN CORP
ONAN CORP
JERRY Mcl�ilIGBT
s�rzv�, Mccvi�
SYLVIA McGDIRB
BINCRNBR BOILDERS
TIM FAHS
TI1K F7�iHS
ENfiBECK CONSTRDC�ION
CLARENCE GRAVES
DON � 1�i1lRY C,�RDA
CARL C�R3STSNSffi�i
ANORA COIINTY PARR� DEPT.
16
250 Longfellow St.
380 Longfellow St.
400 Osborn Rd.
401-.76th Ave. N$.
511 iron�ton St. i�iE.
61i i�fississippi �t.
677 Hugo St.
776-63rd i�ve. NB.
1322 Hillcrest Dr.
1500 Osbome Rd.
1500 Osborne Rd. '
1b00-71st Ave. NE.
1600-71st Ave. NE.
460�-2nd St. NS.
5928 Oakwood l�ve.
5926 Oakwood Ave.
5980 St3nson Blvd.
6105 Woo�y Lane
6105 Woody Lane
6222 Old Centur� Rd.
6229 Sunrase Drive
6443 $ast River �td.
6509 East River Rd.
6666 East ltiver �id.
Jan.
1Kay.
Sep.
Sep.
Mar.
Sep.
Sep.
Sep.
Jul.
Apr.
Apr.
Jul.
Jul.
Nov.
Sep.
Sep.
Apr.
Feb.
Feb.
Aug.
�Oct.
Sep.
Jtui.
Jnl.
SS
8$
Si
87
88
Si
88 '
87
88
88
88
88�
88
87
e�
87.
88
88
88
88
87
88 "
88
88 •
�
sj
!.'
rr^�3 S'�ODOLA 3 RATE GirADBR �68�0 Channel �td. Oct. 88E. H,
�, .iN�R 1� RIC3t I�IAI,AC�ER 7136 East River �td. Aug. 8?
B.H. RsNNER 1� �OISE C�iSC,ADE CORP/BARR 7300 Block & Old Central Aug. 84
E.$. RENNER l� BOI�E CA�CADB CORP/BARR 7�00 Block � Did Central Ang. 84
E•H. RENNBR l� BOISE CASC,ADE CORP/BARR 7300 Block b Uld Central Aug. 84 •
E.H. RBNN$R 1� BOISE Ci�SCAD$ CORP/BARR 7300 Block � 03.d Central Aug. 89
E•H• RENNER 1� �OISB CASCAD$ CORP/BARR 7300 Block � Old Central Aug. 84
E•H• RENNE1t i� BOZSE CASCADE CORP/BARR 7300 Block & Old Ceat�al Aug. 84
E.H. itENNER 1� BOISE CA$CADE CORP/BARR 7300 Bloch 6 Old Central Aug. 89
E.H. RENNEit 1� BOISE CASC�DB CORP/BARR 7300 Block � Old Central Ang. 84
E.H. RENNER l� BOT�B CASCADE CORP/BARR 7300 Slock � flld Central Aug. 84
E.H• RBNNBR i� BOiSE CASCADS CORP/BARR 730�0 Block & 01c� Centrai Aug. 84 '
(10 WEI,LS. . FP7 � i�P10 � FP18 � FP11, FPl'.� � FP9 � FPl i FP8 � F1K8 � FP3 Less Thal� 30' )
[1�iLL OF THTs ABOVE 10 WELLS FOR NATIUNAL POLE � TREATING SITS/1�lEDTRONICS SITB]
E.�. RENNER 1� JAMES L. SCHLEY 7512 East River Road �ep. 87
A-�TEI,L 2 JII�i HAIr! 7551 Aiden Way NE. Jun. 88
ANORA/�018
THE 7�iST DATA ENTRY INTO THIS DOCIIME�iT WAS: NOVEisBER 24th, 1988
�gS i�iU�IBBR OF WELLS SSALEp IN THIS CITY TO DATS: 38
`... ,t
t :
�-�
17
�
�
SUBJECT N O.
c�ty of Fridley 216 2 7�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
� ` RECEtPT NO.
� `y __�__ COMMUNITY DEVELOPMENT DIV. � � �
r � � PROTECTIVE INSPECTION SEC.
' i '
� /"'1 � CITY HALL FHIDLEV 55432 NUMBER REV DATE PAGE OF APPROVED BY
ti.__.11.' '•� 612-571-3450 910-F15 10./29/92 / /
JOB ADDRESS 6810 Channel Road NE
1 LEGAI LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 22 BSO��{V12W AC�.C3.1t1Qri SHEET
2 PROPEHTY OWNER MAIL ADORESS 21P PHONE
Brian/Carla Nelson 6810 Channel Road NE 571�-4843
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO.
5 ENGINEER MAIL ADDRESS Z�P PFIONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK .
Construct a 26' x 28� Addition and a 28'' x 28'' Attached Gapage
9 CHANGE OF USE FROM TO
STIPULATIONS
See natations. on pla�n. Provide a hard sur�ace dri�yeway.
� ������������
� Before digging ca�! fior
: � ali u#ility lOca;�cr,s
SfP�RATE PERMtTS REQUIRED F4R ���-ooa2
w�����, H�ATING, PLUM�1(VG AND SIGNS, �E�U.iRED �'Y LAb'� .
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATiNG, �PE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PEFiMIT BECOMES NULL AND VOID IF WORK OR CONSTHUCTION ZpNING S0. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY 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 BE COMPLIED $S�.�ZH�. $ZSa64
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 HEGULATING coN- 423. SO Fire SC $SI.. Z S
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $
PIAN CHECK FEE TOTAL FEE
$500.42
SIGNATUREOFCON7RACTOFORAUTHORIZEDAGENT IDATEI WHEN PR Y A IDATED THIS IS YOUR PERMIT
s � T� �
SiGNATUFE O O ER UF 0 NER BUILD A� iDATE� • 8 G �NSP � f)AT
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1 N�REBY CERTIFY THA? THE A80VE IS A TRUE ANO CARRECT PLAT OR A SURVEY OF'
-=�`.,;��:.� _,a:,,r3�
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AS SURYEYaO BY MK.TMIS_.-._. �v.:.u.�,_DAY OF_._-.�7. E��...� a....A.SJ.�.y��_ !i= .• . ,
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` , � F. C. J,4CKSON. MtNNE50TA (iEG19TRATION, NO. 360�J
, , /
rtEw � j
ADDN �'
ALTER [ ]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: ((�
Legal Description: �
Owner Name & Address:
Contractor:
Address:
ry
�
Effective 3/1/92
Tel. # ��7/ � r��y�
MN LICENSE #
Tel. �
Attach to this application, a Certificate of Survey of the
lot, with the pro�sed construcdon drawn on it to scale.
DESCRIPTION OF IIVIPROVEMENT
LIVING AREA: Length �!�l Width %-%`� Height
GARAGE AREA: Length �� Width '� a Height
DECK AREA: Length Width Hgt/Ground
OTHER:
Sq. Ft. r �
sq. Ft. ��''�
Sq. Ft.
Corner Lot [] Inside Lot Ft. Yd Sexback %�'� � Side Yard Setbacks /Z� �
Ty� of Construction: a�( � ��1 Estimat� Cost: $ � ���� 1
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Ne�ed: Ft. + 6 Ft = Ft x S =$
DATE: ��) �� APPLICANT: �� . ��-OG� Tel. # �%/ `� �'�.5
1_"7'
W�E#�7��5���
CITY USE ONLY
� ��
Permit Fee $ �° � ;� A
Fire Surcharge $ �� �:�
State Surcharge $ � � �'`�
SAC Charge $
License Surcharge $
Driveway Escrow $
Park Fee $
Sewer Main Charge $
TOTAL $ 5 � � ��
STIPULATIONS:
F� Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$7� per SAC Unit
$5.00 (State Licensed Residential Cona actors)
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agr�ment Necessary [ ] Not Necessary [ ]
. �
BUILDING PERMIT FEE SCHEDULE
The Chief Building Ufficial shall, before issuing permits for the erection of any building or structure,
or for any addition to any existing building or struct�re, or for avy altera.tion or repair to any existing
building or structure, upon applicadon therefore, require tfie payment by the applicant for such permit
of fees to the amount herein below set forth and in the manner herein provided ta-wit:
TOTAL VALUE
$1 to $500
$501 to $2,OQ0
$2,001 to $25,0�
$25,001 to $SO,Q00
$SO,OQl to $1�,�
$10(},�1 to $5�,�
$5�,001 to $1,000,�
$1,OOU,001 and up
FEES
$15 (Minimum Fee is $15 plus surcharge)
$15 for first $500 plus $2 for e,ach additional $100 or
fraction thereof, to and including $2,000
9'►45 for first $2,000 plus $9 for each additional $1,000
or fraction ther�f, to and including $25,000
$252 for first $25,000 plus $6.50 for each additional $1,000
or fraction thereof, to and including $50,0�
$414.50 for first $50,OOU plus $4.50 for each additional
$1,000 or fraction thereof, to and including $100,000
$639.50 for first $100,000 plus $3.50 for each additional
$1,� or fraction thereof, to and including $5�,000
$2039.50 for the first $5�,000 plus $3 for each additional
$1,�0 or fracbion thereof, to and including $1,(�0,000
$3539.50 for the first $1,000,0� plus $2 for �ch additional
$1,000 or fraction thereof
DRIVE�/AY DEPRESSION ESCROV�
(Concrete Curb Streets Only)
Alternate "A": Removal and replacemem of curb and gutter only - Driveway width plus 6 f�t dmes
$13.50.
Alterna.te "B" : Removal and replacement of curb and gutxer and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construcdon 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 conshuction site.
A Certificate of Survey of the lot, showing the locadon of the foundation once it has it has been
constructed will be required before proceeding with the framing.
- � ; �, =
.q
J.f3. t�NnERSON'S �
architectunoJ consultants
�ooe s� aT. s. E. ossoo. �n+. sais' rM_ Nw-sss-�nz
., --_------ --•---. ��_� .::�.�....- a..0
�
Plon '��°`�__._�—�.— Date I a-� w-� Z
Owner� C--�� � �' ' � � ti''�-`'S�a �
Contractor•�
Site Ad d ress:
I�TOTAL EXPOSED WAIr� AREA 13�U sq. ft i�U��' �(
� 5 Z- s4. ft. z'�"� 02�=
2) TOTAL EXPOSED ROOF/�ElLINO AREA
We�� aREA CALCULATlONS�
70TAL WINOOW AREA
GLAZED
70TAL DOOR AREA
TOTAL GLASS DOOR AREA
GLAZED
TOTAL FIREPLACE WALL AREA
10TAL WALL FRAMiNG AREA
NET INSULATED WALL AREA
TOTAL RIM JOIST AREA
TOTAL FOUNDATION AREA (EXPOSE�)
TOTAL FOUNDATION WINDOW AREA
� �
�5
� 5 sQ.ft.z'u'� '�� ?7 ,
�� sq.ft.x�U���� _�
��'. sq.ft. x �U�� � _ "��-
�� sq.ft. x �U'� �'`
I o'= s�,fr,x����,_( o= l C�. s�.
� , / --,
4`� sq.ft.X'u" �a 3= a..�
� % � sq.ff. z�U��' �`�S = � �
� � sq.ft.x�U" ' 1 = � Z-
sq.ft.z�U�� _
3) TOTAL
li iiem 3 is the same as, oi less than 11em l, rou have met the intent of
2 MCAR 1.16008 A and 0.
ROOF/CEtLINO CALCULATIONS�
TOTAL SKYLIGHT AREA
70TAL ROOF��'.EILING FRAMING AREA
NET INSULATED ROOF CEILING AREA
�� _�� �aq.it.z�U"��
1 � �q.�. �iu10U� � � �
�ii �, ., , a�z � �- � �
sq.fl.x U
�4)TOTAL . ��'�
.. If item 41s the some os, or less thcn item 2, you have me/ fhe fntent of
2 MCAR 1.16008 A and 0.
ALTERNATE BUtL�iNG ENVELOPE DESION
.� To utilize the total snvelope syatem melhod, the sum of ltems / and 2 ihall
� be preater thon the sum of ltems 3 and 4. .
1) t2) —
. 3� �� a
� 1 hereby cerHfy that ths bulidlr�p hsre descri6ed meets or �xceeds the ate of sot
EnerQy ConservoNon Act. � �
' /etnnwdl
�
�
a
, . � � ._ �_.-
7ZAMING SECTION
ferior oir Im 0.6B
k .4�
�� inches of soff wood G,b7
� �i" O�.c A.-7 �[oC�
� e�1R�iNil�
■ �I
�xferior air fifm � �T
TOTAL R �
U = 1/R .J.�
ECTION (INSULATED)
inferior air fflm 0 66
Y � s ;2, � 4�
S�P�a,�r 190
- Y u °"` fi� � coCl�
S�oi.at� � � 1
xferior oir film 0 (7
TOTA L R Z- ��? l
U = VR �v
►T SECT�ON
'nferior oir fllm 0 66
SYz� t3,qi•i- � `1 O
1 V�.'' w�n �� Y�9
rt+� o �c ,'� �
�cd%.,
��iNti ���
exferior oir film �.�7
TOTAL R Z�_
U = 1/i� �V�
ON SECTION
inlerlor oir /ilm 0.68
I" �'�^f l� S. c:�
�cor�c.. ��. 1, L �
xferior Qir ilm
0.17
TOTAL R �� ►�
U = 1/R !l�
�
�
e
VENTED
CONSTRUCTION
CEILING SECTION (INSULATED)
( � �interior oir film 0.61
( 2 '��� �±�-�oc.� � sco
, ( 3 �ow.i�, � �si.{� '��
(,; exterior air film {still) 0.61
_ � TOTAL R ,.�..Z�'a
U = I /R , OZZ
CEILING FRAMING SECTION ,
( � interior air film 0.61
(2 °�'b Sa,�TO..�c.� ,Sto
( 3 �wr.h.� I �..��� 33
�q, interior air film 0.61
(5 �zinches of soft wood 4,�5
. TOTAL R 3"�� + �
U = I /R � DZtp
CEILING SECTION i INSULATED)
( � interior air film 0,61
i2
(3
(q exterior air ftlm (still) 0.61
_ TOTAL R
U = I /R
CEILING FRAMING SECTION _
( �.rnterior air film 0.61
�Q
(3
(4 interior air film 0.61
(g inches of soft wood
.TOTAL R
.0 = I/R
EXPOSED BEAM CEILING SECTION
(,� interior alr tlfm 0.61
i2
(3
�4
(5 exterior oir film 0.17
_ TOTAL R
L = I /R
���•��"-� . .
, _ ,..:y,.:
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zt""' �3��^�'- ;,- ����,'�y����^M���i��
", .�y..y� �y
�y„�.ry 'a� h - , � x„ �e =.�.�q?r� ' � t ��"1 ?4:� ci�''��J➢E',
� N� 37.
� .� _ t� � b4'.
. .-
� _� +c. . ._- 6 �," . 1 �'atli "� "�� `�'f�'-:4'".1''°.-_
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�� NOTE: ��1 through 4�8 required when using a side vent furnace.
ii
� �HI�1 FY �11�D STACK VER�CATION
The undersigned hereby verifies that the exisaung chimney or stack:
1. Has b�n carefuUy examin� Yes (� No {)
2. Is free from nist or deterioration Yes (� No ()
3. Has no foreign objects lodged within Yes () No �
4. Is s�ureiy sup�rted Yes �1Vo ()
S. Me� all cvirent Code requirements for size
and totai BTU's connected Yes (�No ()
6 Has tatat heatit�g BTU's of °�O
All other BTU's �.���
TOTAL BTU's �,�%�QO
7. Has a liaer b�n provided for water heater Yes �No �
8. Has combustion air b�n provided for watear heater Yes (�/J No ()
. • i�r..�
,� . .
_�_-- . . _.._.. ! .: _ i � 1 i���
HEATING CO:
Signed By:
Date:
- �'-�1--c7'�
�s L • �y� L � ' �
� �
i
HfAT Lp6S CAL.CUL.�►7'ipNS DEPARI'MENT OF INSPECTION 1�hpVFAppLIg� �L �
�
Wat�ntrips G� Con�trnetion No. Iadation
Wiadow� Doon Refuenee Ou� Wall Ine. Wall Ce�is� Roof.. Floor Kind H�ow Applied �
�4erAo I Y�o 19
Fl.� �` Room Leogth �� QI'dth �� Hei�ht � Fl.� Room Length � Width Height
Windowa aad Doora—Craekage and Ana �� Wmdows and DoorF—Gackage and Area
Wldth ItH�bt Na ot LIn�a1 �ns Wldts BN�et Na ot .LI�1 [t �na
Na o! oaa� ot osoe 11�6b e! oraek �0. tL Na ot �u� ot �n� II�Ab o! oraot p. te.
u
� �; -� � � �' �x. 20 � �' � ! � C�
� �� —
.
c� s� � c� �� �
1n61tratioa
��
�.,�u s
Net c:p. we11
Iat waU
CeJing
Floor
Total Btu.
Required sq. k. E.D.R. or �q. m�. WA LRader srea
Fl.� �.'' Room Leogt6 W�dt6 ;
Wmduwa and Doon—�Cracka�e and A�ea .
Wldts He1�at l�a ot LInW !t �ru
Na ot �ns ot paas tl�Lq ot vaek_ q• R
C�aa �
E�- wan 0
Na ap. wall
Ina waU
Ceiling
F'loor
Total Btu.
Required aq. it. E.D.R or �q. ios. WA L.eader ares
1 Fl•I I��,��, � I �� �,�
� � aed Doon--Craeka�ee and Area
In6ltrataa
Glass
Fsp. wall
Net ap. w
Iac. wall
Ceiling
Fl.�_
h. E.D.R or w. +n�. WA. i.eader area
��� ��.a�n
�2� �
� �� �
InG wall
���b C���g.
�'
7C[.1 O�Y
..=�
�Ben
Total Bto. � -
RequQed �q. ft. E.DR or �q. ina. WA Leader area
�. Fl.I �3 R� I 1.�� 2o W� /.
Qimdows and Door�--Craekase and Area
GIW
��
Net esp. wap
In� wvl
Csiling
Elaor
iicquiced M. it. F D.R. or �. ma. wA. Lead�er area
Fl. � � t�w� cv�v� _
I� �V'mdow� amd Doon—Cracka�e ,ad Are.
Infilr.ation
Cd�u
��
Net esp. w
Iot. w�►Il
CeJ' ing
I Floor
tt. r..u.K. or tq. mi. w.w. 1.eaaer area
T � �
Btu
HOUSE HEATING TEST RECORD �_?2-�/,"� I
�cu�e� ' 4
, k.� �' ' , � ' �` APT. FI.00R CITY SUdWRB �_
OCCUPANT� , - � ` � 01rNER � � � � i
HEAt LOSS DATE HTG. INST. , i
SOLD BY INSTALLEO BY ;
El.ehieol Wo.k' Br Ges Lin. Br !
�-
TYPE OF HEAT GA FA . HMf STEAIiA SPACE HTR. UNIT HTR. OTHER �-
' , �� (�1►S DESIGN CONVEREION
MAKE ' � � .., MAKE OF BURNER
Mod�i � � _ Morel
S«iol ' ? � L—= ; �—;� � � _ _ Mox. BTU Ratiny
INPUT ' ,' �.¢ -f �� � MAKE OF FURNACE
Mod�l
CONTROLS �., � �
THERA405TAyT � H�o� Pluy "� V�nt Siz• �
Volv �{ ��� KIND OF LINER f� �--� S12E : r�,. �_NONE
Limit +:�}X - D�ah Hood - R�ule�e�
r.. t-`
Limit S�ttin9 ' Fi (t�►s Si:� � � - �
Fo� S�Miny Chhnn�y Lxetion � sid� E)ufsi�j
Pilot Trp� �. _' , _�,. . C6imn�y Consnvetion , � .y .. .
Pilot Mob
Pila Mod.l Snwk• Bomb Wi.in9 ' r�
Pilot Timiny Droft �< .�-'."- T�st To9 �' �
�.W. Cut Off Doe.. Pr�:sur� Li�tins Iwst. �'°
;= �ti � � �
_, ,-- _ ;
Pr�ssw� �'-'' P�rc�nt COZ �'� Dot� T�s»d (�
( =.
��1 : �. '., : �
InputCFH f' Pac�nt 02 �''' '' Compony T�sting Z-�'ti �:!� � �-. �
Stack T�mp. P�runt CO Nan» of T�stK F `�'� ��� �
,. .....__ =
Forw 2�5 �°r... ' t_ � ,. .t,7x _..'
� r
City of Fridley
AT TME TOP OF TNE TWINS
i �
� �
� �y ����� COMMUNITY OEVELOPM�NT DIY.
r � � PAOTECTIVE INSPECTION SEC.
� j �"'1 : CIFY NALL FF;IOLE� S31J2 N�
�'""��� ��� 612-571-34b0
JOB ADDRESS 6810 Channel Road NE
t LEGAL �OT NO. BLOCK 1'NACT OR
oescR. 22 (1180) Brook�
2 PROPEiiTY OWNER MAIL ADO�iQS$
Brian & Carla Nelson
3 CONTiiACTOR MAIL ADORESS
Midwest Timberoof 1001 E. C1iff Rd,
a ARCFIITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAIL ADDRESS
8 USE OF BUILOING
Residential
7 CLASS OF WORN
O NEW ❑ ADOITION
B DESCRIBE WORK
Reroof house (11 Sq) Tear-off
9 CHANpE Of USE FpOM
STIPULATIONS
��« �
�U ILDING PERMIT
iBE9 R@V O�TE PAGE Of
siaF�s 7/6/99 / /
21P
��
PMONE
PMONE
PMONE
�29823
EIPT NO.
����
APPROVEO BY
SEE ATTACNED
SFIEET
LICENSE NO
G7-�
LICENSE NO.
LICENSE NO
O ALTERATIpN �C qEPAIR O MOVE O REMOVE
TO
Underlayment must comply with theState Building Code.
SEPARATE PERMI75 ARE REOUIREO FOR ELECTRICAL, PLUMBING, MEATINCa, TYPE OF CON T.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WOfiK OR CONSTRUCTION IONING
AUTMOR12ED IS NOT COMMENCED V+(ITHIN 80 DAYS. Ofi IF CONSTRUCTION
OR WORK IS SUSPENOEO OF ABANDONEO FOR A PERIOC OF 1p0 DAYS A7
ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNI
I HEFEBV CERTIFV THAT I MAYE REAO ANO EXAMIN�D THIS APP�ICATION
ANO KNOW TNE SAME TO BE TfiUE AN0 CORREC7. ALl PROVISIONS Of �AWS VA�UATION
AND ORDINANCES GOVERNING TMIS TYPE OF WpRK WILL QE COMPLIED
WI7H WHETHER SPECIFIEO MEREIN OR NOT. TME GflANTING OF A PERMIT $961
OOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL 7M� pEWMl7 FEE
PROVISIONS OF ANY 07NER STATE OR LOCAI lAW REGULATING CON-
STRUCTION OR TNE PERFOfiMANCE OF CONSTqUC710N $3H.7J
S�GNATUAE O� CON"AACTOA Oi1 nUTHOpiZED eGENT 1DAT6
��GNAtUqE O� OWNEpdF OWNEABWIDEAi _ IO�fE� -
Piermit Inspection Cards
To �i�� Be Matled
Homeowner To Post
S�. FT
Of f STiil
STAILS
SUR7AX
. .50
SAC CM/
Fi re
TpTAL F
�5 00 45.
RI,Y V/,�IDATED THI$ I
n �� ��
OCCUPANCYLOAD
CU FT
f pARKING
GARAGES
T
� � _�c:r- ,��- � ��Gs
�..
v�W r ]
ADDN [ ]
ALT'EI�. �j'
r�
13 � �.� FF'i iPi �= I T' i OF FF: I L�L� �' TCi
CITY OF FRIDLEY
5A1T�LE �'AMli'Y AND DUPLEXES R-1 AND R-2
BOE�i'��1 F,G�l'C�G
�ftective 111I98
�, Y,,,;� ° � , �
BUII,DING pERMIT APPLICATIDN
��
,� p �I ��
�onstructionAddress: _(Q� ���, �!���1. � 1� �; - --- ��
_ �
I.egal Description:
Owner Name 8c Address: �nCY �°!CA,�let'�,I�n 1�810 Chan�if�� N��IC�I�V Tel. !f I�12'.r'J� f-�'��'�J
Contractor. M�,(��(ll��`�'i�(1i�� , MN LIGENSE �} � I y%��a,0 _
Aadress:, j��s �� CLI-F(' YGi ���� 14 �l �2 ��n 5�33� Tel. �(D�Z-gO��- � I°1
Attach to this application, a Certifi�ate oi Survey of thc
1at, with the pcoposed const;vctidn drav�+n on it to seale.
D�'SCRIP�'IO�i UF IMPRpV'EMENT
LZV�.N� �A�: %ngt� _ -- Wid[k! �Isi�kac � Sq. Ft.
�l�RAGE A1�tEA: Length Wfdch � Height Sq. Ft.
DLC1� AREA: Len�;th Width�� �IgtlGround Sq. Ft.
OTHER:
L
Conscruccion Type:-`,�pin U !�b°� �lQi� Estimated Casc: $ '�j�-�� , �° �C�n/
—�--
(�'ee s�hedraZe on �ack)
Drivewi�y Curb Cut Width Needed: Ft. + 6 Fi = Ft x$ �$
DAT�: � APPLICANT: J � G fii.1�.� `�-�'� �el, # ��D IZ- � ��' _� I � �
� �l - -- -
Permit �ee
Fire Surcharge
State 5urcharge
5AC �harge
License Surchazge
Driveway Escrow
�rosion Contral
Par�C Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� ��� s0
$ i' Co
$ ��
$
$ �-c.��
$
$
$
$
$ � ,�/
CITX USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuatian (l/1(hh%)
$.SO/$1,000 Valuation
$1000 per SAC Unit
$5.00 (St�te Lieensed Residential Contractors)
Alt. "A" or Alt. "H" Above
�450.00 Conscrvation Ptan Review
F�c batermined by Engineering
Agretment Necessary j) Not Necessary ( j
_ �'2
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