AF - 37075-� , ,�,
City of Fridley, inn
BUILDING PERMIT
Da�; October 5, 1970
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N° 108511
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Adclresa 6846 Channel Road N.E. Ad� 244 Fairview South
No. 6846 S�t Channel
Lot �q _ Block �
Coraer Lot — Ins3de Lot
Sewer IIevation _....
To be Used as:
H� Reside
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1�pe of Construction ,`
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,TION OF BUILDING � �
�.E. Part oP t /
Addition or Sub-Divisian �� !a �� u n✓
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— Se�back __._ Sid �
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_ �ounda.tion IIevation i,' - - -- -
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- Depth
^ ti
Depth
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�nm � ��. F�t. Cost
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Height �_ 5q. F't.
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fTeig't;t —,.,! -- Scl. F't
C�i. F't
Cti. FL
To be Completed —�. ��ks
�-�ons�Lderation of the issuaace to me of a permit to construct the building described above, I agree ta do
the proposed_work in accordance with the deacription above set forth and in compliance with all provlsiona of
or�lnances oP the cfty' of �'riidley. �, `�,�
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In camsfderatton oP the payment of a fee of $�.Q.A._._.., permit is hereby granted to t Inc .
to construct the buflding or addition as descrYbed above. Thiape rmit is granted upon
the express condition that the person to whom ft is grantea and his agents, employees and worlflnen, in all work
done in, around and upon said building, or anypart thereof, ahall conPorm 3n all respects to the ordinsnces of
Fridley, M9nnesota regerdi�g la:ation, constructfon, alteration, ma3ntenance, repafr and moving of buildings
within the dty ]imits aad this pernait may be revoked at any tiaae upon violation oP a�ay of the P�vi�tons of sa�d
�dinaac�.
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GL.ARF.NCE BEL 7' •
NOTIC�
'hils permh d�s eot corer �6s eo�dioe, testallaHon fe� vrUtee, plumbtee, ea 6eadee, ssws� or wmr. Be sure to ies
tk� Bntldie8 lesp�etar M� wparaN psrmtls foe fhess It�m�.
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APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADllITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME • L BUILDER:�� a�—s�.�+, t-�
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ADDRE�aS : � ADDRESS : � � � � - —�� o
NO•. STREET:
LOT: BLOCK• ADDITION•
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
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Applicant attach to this form �Fao Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
HESCRIPTION OF BUILDING
To Be Used As: !
� � �-p /tf P' Front : Depth : Height :
Square Feet: Cubic Feet;
Front: Depth: Height•
Square Feet• Cubic Feet:
�� �
, �rpe of Conatruction:- — — Estimated Coat: $ � � �'°
To Be Completed:
The uadersigned hereby makes applicativn for a permit for the work herein
apecified, agreeing to do all work in sticict accordance with the City of
Fridley Qrdiaaaces and =uliuga of the Department of Buildings, and hereby
declares that all the facts and representationa stated in this application
are true aad correct.
DATE : / �'� � � � / � S IGNAT[TRE • � i6�'�
(See Reverse Side For Additioaa,l Information.)
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing pennits for the
erection of any building or structure, or for any addition to any existing
building or structure, or for any alteration or repairs to any exiating
building or structure, upon application therefore, require the paymeat by the
applicant for such permit of fees to the amount herein below set forth and in
the manner herein prwided to-wit:
UNIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building pern�i,ts, the cubical contetits
of any building or addition, is determined by multiplying the ground area
covered from`'a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average.•
height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In ao case shall the fee charged for a.ny permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours fram the
time of application, to allow for proper review of the proposed structure aad
of the coastruction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceedinr� with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy qf any structure for which a building perniit has been
issued; and said structure shall not be used or occup�ed until a Certificate
of Occupaacy has been isaued. •
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SUBJECT
City of Fridley 14384
AT THE TOP OF THE TWINS g U I L D I N G P E R M i T
� � ECEIPT NO.
� ; L __�_ COMMUNITY DEVELOPMENT DIV.
r �� PROTECTIVE INSPECTION SEC.
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, -_„� �"h'� CITY HALL FRIDLEY 55432 NUMBER HEV. DATE PAGE OF APPROVED BY
L 812-580-3450
910-F15 9/22/77 � �
JOB ADDRESS 6846 Channel Road N. E.
1 LEOAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 19 $L'pp]{p].C.'W At3CI1't1.021 SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
James Stu}�bs 6846 Channel Road N.E.
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
G& B Construction 3888 White Bear Avenue ?�29-5068
4 ARCHITECT OR DESIONER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW �O ADDITION O ALTERATION ❑ REPAIR ❑ MOVE 0 REMOVE
8 DESCRIBE WORK
Construct a 2U' x 8' Addition
9 CHANOE OF USE FROM TO
STIPULATIONS
Provide smoke detector in bedroom area.s
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SEPERATE PERMITS REQUtRED FOR � 1NIRI[�G, �eiore di�ing c�l! facaE �i�s�$�s
TEIEPFtONE • ELECTRtC • GAS �t�,
��afin�. PLU��� a�p SrG�S. � R�E��IIRED BY l,�Vy
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
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 $8�986 $�i.49
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
PROVI tONS ANY OTHER STATE OR LOCAL LAW REGULATING CON- $16.64
STRU TION TH PERFORMANCE OF CONSTRUCTION. �
PLAN CHECKFEE TOTALFEE
�, $ 4.16 $25.29
SI ATUREOFCONTRACTORORAUTHORI2EDAGENT IDATEI HEN PROP RLY VALIDAT D THIS IS YOUR PERMIT
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SIGNATUREOFOWNER(IFOWNERBUILDERI IDATEI BLDG iNS DATET��
CITY OF F(ZIDLEY
APPLICATIOl�J FOR RESIDENTIAL BUILDING. PERI�tITS
iNEW, ALTERATIONS,. ADDITIONS, OR,REPAIRS)
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OWNFsR: �' ,�-, �' - , . � _�;5��_:�' BUILDER: � � ',:.�?��� .
Address S f� � ��A� ���-��rT,e�.eO����� Address : �� � � �_�.a�Q��'�- ��t,�°�&_� �'- ti �� ~ + i= �o�`
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Tel . No . �d � � ° �`� � �r � �.
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No. : �� Street : �� ��°�?�-� ����^ � �� �� �=� �'
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LOT: BI�(1�Y.: ADDITION :
CORNER LOT: INSIDE 7AT: SLTBI�CK: � SIDEYARDS:
Applicant attach 'to tliis form �ao Certificates of Survey of Lot and proposed
building location drawn on these Certificates. �
DESCRIPTION OF BUILDING
To Be Used As: `
• ,l , /
�� Front: � Depth: �' ° ` Height: ,1 �
Square Feet: � Cubic Feet: ��6�
Front: Depth: � Height:
� 5quare Feet: Gtitbic Feet:
Type o€ Construction: �.� �, Estimated Cost: �� ���4� �' �``�
�-. .t � .
To Be Com leted: � �� � : �
P Alt. A Alt. B
Proposed Driveway Widt� If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict acc�rdance with the City of
Fxidley Ordinances and rulings of the Department of Buildings, and hereby
declares that alI the facts and representations stated in this application
are true and correct. See reverse side for additional inforniation.
DATE: SIGNATURE:
Stipulations:
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BUILDItVG PERt�IIT FEt SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issui.ng permits for the erection
af any building or structure, or for any addition to any existing building or structure,
or for any alteration or repairs to any exis ting 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:
NEW CONSTRUCTION: Single Family Homes and �arages: $4.00/1,000 cubic•feet.
PLAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSION: (Concrete Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6�eet x$11.75
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3 foot wide approach with
6 inch depth; Driveway width plus 6 feet x$15.40
: 11 � : 1 �' : �
For the purpose of computing fees for building permits, the cubical contents of any
building or addition, is determi.ned by multiplying the ground area covered from a
point six (6) inches below the floor line of the basement or the cellar to the
average heights of the upper surface or to the average height of the raof surface
of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the rate
of $3.00 �ier each five hundred dollars ($500.00) or fraction thereof in the cost
of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be less
than $7•50 plus $.50 state surcharge.
VERIFI .ATION OF FOUNDATIOt� •
1VOTE: Permits �or construction will be issued a minimiun of 24 hours from the time
of application to allow for proper review of the proposed structure and of the
construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
_ i ' � � � � �
---- -- -- .��.,.�.�
Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occupancy of any structure for which a building permit has been issued; and
said structure shali not be used or occupied until a Certificate of Occupancy has
been issued.
7
ELK RIVER CONCRETE PRODUCTS • 8609 LYIVQALE AVE., S0. • BLOOMIN6TON. MlNN. 55420
16�Z) 884-7362 • IdWARD VYATS - S00 -�- 552-1158
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SuBJECT ,
c�ty of Fridley o� 17 4 3 9
, ` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T REC
r
� ; V �������
COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. �r �j'{�7
� � � / O' 7 /
`-_-_� � ���,•� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV
s� 612-571-3450 910-F15
4/4/84 / /
10B ADDRESS 6846 Channel Road N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ],9 Brookniew �C�].t:lOri SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Jim Stubbs 6846 Channel Road N.E.
3 CONTFiACTOR MAILADDRESS Z�P PHONE LICENSENO.
Western Construction Ca. 5353 TnTa�zata Blvd., Mpls. 55416 546-3385
4 ARCHITECTORDESIGNER MAILADDRESS 21P PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
R�'.3 ].C�EI2'f:7.1�.
7 CLASS OF WORK
� NEW X ADDITION 0 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WOflK
Construct a 20' x 24' Attachecl Gara e
9 CHANGE OF USE FROM TO
STIPULATIOIdS provide a hard surface driveway.
D1�NEWAY E&CROY�T: 12" -k 6' = 18' x$13.50 =$243.00
��RNING t``x
��efore di�,�,� �EPERATE PER{�ITS RE��i��Efl F�� V�d1R��v�
T������ � ElECTRIC a GAS�Etc�
a���-r'cac. P�.aa�B��r �r�� s��n�. .
�������6�ED BY CAV�
TYPEOPCONST. OCCUPANCYGROUP OCCUPANCYLOAD
SEPARATE PERMITS ARE REDUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. 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
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS /CPPLICATION �- 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 $`�j �3$O. SO �`2. %O
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
PROVISI F ANY OTHER STATE OR LOCAL LAW REGULATING coN- $56. SQ
STRUCTI R HE PE FORMANCE OF CONSTRUCTION.
� PLAN CHECK FEE TOTA$L`�EE 20
>
SIGNATUREOFCONTRACTOROR ZEDAGENT A7E� WHEN PROPEF VALIDATED THIS IS YOUR PERMI
- �r
< �
SIGNATUREOFOWNER��FOWNERBU1LDEii� IDATEI BLDG INSP � E
NEW [� City of Fridley Effeetive 4/1/8�
ADDN. [ R-1 AND R-2
ALTER. [ ] Building Permit Applieation
Construction Address: V� ���
�'/L'.���2� ��
Legal Deseription:
Property O�ner/Addres .- -S��% Tel. # ��7' oa��%
Contractor: v/� - Tel. � �� �
Address
LI97AG AREA:
GARl1GE AxEA:
DECg AREA:
OTHER•
Attach to this application, a Certifieate of Survey of the `,�'�
lot, with the proposed construction draWn on it to scale. �`�`�
` �° � � �
DESCRIPTIOH OF IMPROVEMENT �> i� �-°°"
Length
Length � �
Length
Width
Width .�
Width
Height
Height �
Hgt/Ground
Sq. Ft.
Sq. Ft. 7 ��
Sq. Ft.
�1 c /� ►
Corner Lot [] Inside Lot � Ft. Yd. Setbaek j Side Yard Set aek 'I—!�'
Type of Construction: ��� �`� Estimated Cost• $
Approx. Completion Date : � �� , ,\ � S 3 gG � �
� Alt. A Alt B
,
Proposed Driveway Width If New Opening Is Desired: � I/ l��� �� �a'��.�0 $
�. See Back Page for Explanation
DATE: �// ��/
Permit Fee
Plan Check
State Sureharge
SAC Charge
Park Fee
SeWer Main Charge
TOTAL
STIPULATIONS:
� C�.� �� � �.�
APPLICANT: �' � Tel. � V .�LJ
CITY IISE ONLY
�
$ �.�3 Fee Schedule on Reverse Side
$ �i° 25`� of Building Permit Fee
$ � ��� $•50/$1,000 Valuation
$ ° $425 per SAC Unit
$ �� Fee Determined by Engineering
� ��
� � ..�0 Agreement Necessary [ ] Not Neeessary [ ]
$
BUII.DING PERMIT FEE SCHEDIILE
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 atructure, upon applicatio n
ther.efore, 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 Valuation
�1.00 to �500.00
Fees
$10.00 (Minimum Fee is �15.00)
�501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each
additional �100 or fraction thereof, to and ineluding
$2,000.
�2,001.00 to $25,000.00 $32•50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraction thereof, to and
including �25,000.
$25,001.00 to $50,000.00
$50,001.00 to $100�000.00
$100,001.00 and up
$170.50 for the first
additional �1�000 or
including $50,000.
$283.00 for the first
additional $1 , 000 or
including $100,000.
$25,000 plus $�.50 for eaeh
fraetion thereof, to and
$50,000 plus $3.00 for each
fraction thereof, to and
�433.00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof.
DRIVEWAY DEPRESSION ESCROii
(Concrete Curt� Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus
6 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 xidth plus 6 feet times $15.75
9ERIFICATION OF FOIINDATION
Permits for construction xill be issued a minimum of 24 hours from the time of
application to allow for proper review of the proposed structure and oF the
construction site.
A Certificate of Survey of the lot, shoWing the location of the foundation once it
has been eonstructed will be required before proeeeding with the framing.
0
� /� ��i.
�,��,... .
. �
�a � _ _�-� - �._A.�.� _ �.���,�-��
� ... � �:
� h J 4� � L� .��),i.J:J.I%.7 3.SY l>�. L��PI 4.': i�. �t� �1412 �i�1 4f ? �'I
— � «
• O 0 ._.-�.-....,.�,-.. _..=_.r.rc.�:,--.+.e��.,.-���...+.�.aw--:-•.�o.w�'"�'
_ +�47.LR.` �_aR�"� .�'�� )�-�,���'.� �e��dY r�,��'k;'
5353 Wayazata Boul�vard � � �,';�",;�-* ;}I:di��t �y.�r�.� '�,� p; ; °� �' f g`j
. �.Y .'a.r' i� �.1�1,Jt1:�:,% .Y.�� �s'�.+�.f.1�6�_i
RRinne�polis, Minnesota 65416
b46-3385
CITI' "'r:���.��
,�;is.i,t:; +,�t�''r�i. 3. -, :''� "'}t��, � l.a • _.'�� •
ADDRESS
NAME �:a-��� �t� �z,, = x��.r�,�.
� �`1�-� ��"� <,:''�
TELEPHONE WORK
PERNiIT OBTAIIVED BY
SALESMAIdI ��'�'��'�
CEMEIVT MAN �'� `'" -- � _-. ```:`'
OLD GARAGE REMOVED BY
OLD CEMENT REIIIIOVED BY
� �
�_�- ;
�{. �__l � ��.
�.,
�_..__ _
���
_:_ ��`_ i ..L.i'i"
.�.�.-' .�,L _'�---�_"f."'-.
� � l." ' �_'d.-.�__.1..
_'�'� �'..yl,
_}�'� __}. -i. _f... -
� 1__�-+
i`- 'j.�`_�'�
, � � + I--+F—� �
� , �+"_-_�� ' � -�-�
, ; --�-�� ; -�
,. ' �-
-; -t,, ' - --�-. �-
�_ �M, � _�-- .
,;,- -
� �. __. _-_�- _ ._ -_ -
_�--, ± fA �. t ' +��--�$ �.�-
-� � �._.l.- Y--,-.r a� —�_—�-�_�-
t
DATE � ^' r�"�,,`�;:a'.a,
GARAGE SIZE ��° X �� X°� APRON�.. ��;
DRIVEWAYSIZE ��'�4��'r "L��'���� ���`'���'��' u�`�e ��'��,
r,
�`'`-m WIRE MESH '/z"=RODS CONDUITPIPE
OVERHEAD DOOR SIZE `�'�'�� OFFSET '°J�Y �,
SERVICE DOOR LOCATION �'�"� �"' �'��-"�'-''�
?; f3
BLOCK SIZE & LOCATION 'S �'`'`�' '
WATERPROOF BACKFILL
EXCAVATIOIV BY -
, -: r,
GRADEFLAT DROPOFF =
,;�
��e:��:��'s.=3�'� . �
.�......_ �._. � .. � . p-•.�t__.t._.y..... �_.y�"'
.._ �
' t , . � f Y 1 f 1 ' .... , ,
-_ ✓.:.. . _:.._I........y _' .•-�-.__i-_�_ S �
, . . , , . . � . . _r _- -. ..` t..-r—�---1---k- . -�---r
,duilding
Inspections
763-572-3604
DA'fE I ° I � �% �
STTE ADDRESS �
THTS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATTON
PROPERTY TYPE
PERMIT 'I'YPE
TYPE OF WORK:
BUILDING �i. ��
RESIDENTIAL APPLICATION
CITY OF FRIDLEY 20�-
YOUR E-MAIL ADDRESS
O OWNER �ANTRACTOR
�'� �
PHONE:7LT �� f ° O � `�_
STAT'E LICENSE
DATE
❑ ADDTTION ❑ GAR.AGE/SHED
O BASEIv�IJT FINISH BROOF
❑ DECK O SIppJG
':' � .: .'C15R�vA�II1�iG POOL
O NEW ❑ ADDITION
O MAIIdTENANCE/REPAIIt ❑ REMODELWG
DESCRIBE WORK BEING DONE: %�st.�'I.
SIZE OF IIV[PROVEMENT
NUMBER OF SQUARFS �
GARAGES
PROPOSED SIZE:
PROPOSED I-�IGHT:
SIDING
❑ Vinyl
O Aluminum
0 OUter
❑ HOUSE & GARAGE
❑ ATfACHED GAR.AGE
O DETACHED GARAGE
OSoffit
❑ Trim
❑ Fascia
VVUVDOWS
IN EXISTING OPENINGS OYes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPEMNG CHANGES &
NUMBER OF
PernutNo.: �D�° v�3
Received By: .
Date Rec'd: � �l%�
�.
CITY STATE Z�
❑ WINDOWS
❑ DRAIIJ TILE
O OTHER
HEIGHT
BASEIv�NT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft.
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCI-�S SUBMIT:
1. Site Plar►/Survey showing the existing structur
and pmposed proje�t.
2. Two sets of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: '
(USING 1997 U.B.0 FEE SCHEDULE)
TOTAI. �Ok.' VAL'�JA'd'IOl`T S o2 c�s, � OCC�ANCY TYP�
Permit Fee $ See Back Page for Fee Schedule
Plan Review $ —n�--� 65% of Building Permit Fee
Surchazge $ J. �� (.0005) times the total job valuation — Minimum $.50
Fire Surchazge $ �,/�� .001 x Permit Valuation (1/10%)
License Surcharge $ �' � c, $5.00 (State Licensed Residential Contractors)
SAC Chazge $ $1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft+ b ft= ft x$20 =$
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Chazge $ Agreement necessary () Non Necessary ()
Total Due $ ,/A Make checks pa able to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMTf-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I owledge that the information above is complete and accurate; that the work will be i
conformance with the ordinances codes e City of Fridley and with the Minnesota Construction Codes; that I understand this is not
permit but only an application fo d work is not to start without a pertnit; that the work will be in accordance with the approve
plan in the case of all work u' vi d approval of plans.
SIGNATURE OF APPLICANT PR1NT NAM �/v � I��% DATE �°/ /`� �
Page 2- Building Residenti�.l Application
BUILDING PERNIIT 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 structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
provided to-wit: � .
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
allow for proper review of 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 � a
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
Building
Inspections
763-572-3604
�� �
srrs �wnr�ss �
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
BTJILDING ,295! z� I Permit No.:
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
' YOUR E-MAIL ADDRESS _
�1 rl�r9Ne /� /V �
❑ OW1dER J�ONTRACTOR
NAME: i � ✓��
nnnt�ss: lp5?�� Ch.�r�/ � N
PHONE: 7�3 �%�%- � 2 2 g -
SUBMIT A COPY OF STATE
YOUR STATE LICENSE ADDR
WITH APPLICATION pHON]
PROPERTY TYPE ❑ s�'
FAMILY/NEW
Received By:
Date Rec'd: : d��n
EXP DATE � °3 — `;/ • OCr
� �S � Z
CITY STATE ZIP
2-�.i?�
PERMIT TYPE ❑ ADDTTION u U,at�aurr�r�� �w�,v,.,vw�
❑ BASEN�NT FINISH O ROOF O DRAIN TILE
❑ DECK 1�aSmING O OTHER
. ❑ SWA�MING POOL
TYPE OF WORK:
O REMODELING
DESCRIBE WORK BEING DONE: =lMl � � /�
SIZE OF IIvIPROVEMENT
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSID HEIGHT:
SIDIIVG
O Vinyl
O Aluminum
O Other
WINDOWS
IN EXISTING OPEMNGS �,Yes ONo
OR FOR NEW OPENII�TGS-DESCRIBE SIZE OF
OPEI1II�iG CHANGES &
'TYPE OF W[NDOW TO BE INSTALLED �/''�
❑ HOUSE 8c GARAGE
❑ ATTACHED GARAGE
O DETACHED GARAGE
OSoffit
❑ Trim
O Fascia
LACATION OF WINDOWS
� " 2 /e%NUMBER OF WIl�TI
HEIGHT
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft
FOR NEW CONSTRUCTION 1NCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the e.xisting structures
and pmposed project
2. Two sets of conswction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $��a�D �('J OCCUPANCY TYPE
Permit Fee
Plan Review
Surchazge
Fire Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due
E��i�
$
$
$
$
$
$ ,
See Back Page for Fee Schedule
65% of Building Permit Fee
(.0005) times the total job valuation — Minimum $.50
.001 x Permit Valuation (1/10%)
$5.00 (State Licensed Residential Contractors)
$1450 per SAC Unit (Plans to MWCC for deterniination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks oavable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building pernut and I aclrnowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes e City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
pernut but only an application a pe ' d wor is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work w' ie approval of plans.
SIGNATURE OF APPLICANf PRINT NAME / v� �a-�� ��/'DN�R�DATE .9 '�' �D � ��
Page 2- Building Residential Application
BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing pemuts 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 shvcture and of the construction site.
A Certifica.te of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv s
Cit�r of Fridley -- -
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977