AF - 37098�,
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City of Fridley, inn
BUILDING PERMIT
Date: � JULY 2z 1965
Oamer: LYLE QUAM g�� SAME
Ad�re� 6.895 Channel Road Addr�
Fridley 32, Minnesata
LOCATION OF BUILDING
No. 6895 S.�t Channel Road p� of Lot _
Lot Block Addition or Sub-Divisian
Coraer Lot Insfde Lot Setback � Sideyard
Sewer IIevatiam
Foundation IIevatton
� ��a j
N° 8111
To be Used as:
Front
Front
Zj►pe oP Conatruct4on
DESCRIPTION OF BUILDING
Depth Height Sq. Ft Cu. FL
Depth ITeight Sq. F� Ctl. Ft
r, �, � 6� 5 00. 00 _ To be Completed
REPAIR HOUSE STORM DAMAGE • REBII77,D GARAGE
In �deration oP the 9�uanc� to me of a permit to construct the building descrlbed above I agree to do
th� proposed work ffi aceordance with the d�scrlpl3on above aet fo in complian . afl pran►iaions of
orrlinances oE the dtq oP Frldley.
� �
�
In comsdderation of the payment oP a fee of $ 10.0U , permit ia herebY graated to LYLE QIIAM
to conatruet the buflding or additioa ea descrlbed above. This �ermit is granted upon
the exPreesa c�tditlon that the peraon to whom it is graated and hfe agents, einployees and worl�en, in sII work
done ir►, around and upon eaid building, or anypar� thereof, shall conform in aII respects to the or8inancee of
��Y, Mi�onesota regarrlin lacal3on, constrttction, alteration, maintenance, repafr and mov3ng of bufldinga
within the dty limfts and � permft may be revoked at any Lizne upon violation of aay of the provasiona of eafd
or�inaaces.
ALLEN G. JENSEN ��g ��
NOTIC�
Tldt pRm� dea eot eorer ths eeesfeasrlae, te�a1)alloe hr 'Wtrtn9. P�+d+e. Y+� 6i�9. aw�r er rmr. B� sun im a�
Hu Boildtne I�tar ;ter aP+U+h p�s fo� thw �.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLLY, MIPIl�ESOTA
OWNER' S NAME fj{. C�. �� /�. l G° � BiT�DER�. ,-
ADDRESS � � � � � ��ADDRESS
� T-
LOCATTOIV OF BIIILDING
N0. STREET ` y �A�tT OF LOx �--�
LOT BLOCK ADDITION OR StTBDIVISION
C�ItNER LOT�INSIDE LOT SET$ACR SIDE-YARD
SEWER ELEVATION � FOUNDATION ELEVATIOR .
Applicant attach to this form Two Certificates of Survey of.Lot aad proposed
building location drawn on these Certificates.
To be used as;
DESCRIPTIQN OF BUiLDING
� Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth $eight �
Sq. F't. Cu. Ft. - �
Type of Construction ���+� Eatimated Cost i� �
To be completed � '� �
The undersigned hereby makea application for a permit for the work herein
specified, agreeing to do a11 wo�k in strict accordance with the City of
Fridley Ordinances.and ruliaga of the Departmeat of Buildings, and hereby
decl,ares that all the facte and repreaentations stated in this application
are true and correct, '
DATE_ � '!' � `�- �� SIGNATURE � "e � eiUL� ,
(Schedule of Fee Costs can be found on the Reverse Sidej. / ��
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BIIILD�16 PERMIT FEE SCBEDULB.
SECTION 2. The Iaepector of Buildinge sinall, befQre issu3ng anq permit for
the— ere tion of any building or sta�ucture, or for any addition to aay exieting
building or atructure� or for any alCerations or repaira eo any esieting
build3ng or et�ucture, upon application therefore, require the payment by the
applicant.for.such�parmit�of fees to the e.ffio�,nt he�ein�below set foreh and in
the manner herein provid¢d to-wit: .
2_ 1: For any such permit for the erection of any.fire-proof building,
other than a garage, warehouae, factory or grain elevator, or for the erection
of any fire-proof addition�;for eimilar occupancy, to any es�sting buiiding,
ahall .b� at. _Che rate of $],.4� for each .one thousand .cubic feet, or fraction
thereof, in auch cubical conteats.
2_. �'or any such pe�mit for the erectian of aay fire-proof g�rage.,
warehousey faetory or grain elevator, or for the erectioa of�any fire-proof
addition, fo; eimilar occupancy, to any•exiati.ng buildiag ahall be at the
rat� af $1.25 far�each one thousand cubic feetf clasatfied as "fireproof"
by Section ,502 of:the.Minneapolis Building �ode. .
flOIISES
2_ For any such permit .for the erection of any non-fireproof
building, other than a garage, warehouso, factory or �rain elevator, or
any noa-fireproof addition, for similar occupancy, to any existing building -
permit $1.00 for eech one thausand cubic feet.
GARAGES ~
2,4. For auy such permit�for tho erection of anq non-£freproof garage,
warehouse, factorq or grain elevator, os for the erection of any aon-fire-proof
additfon, £or similar vccupancq, to aay�esisting building or for each such
building or addition - ninety centa ($0.90) for each one thousand cubic feet
or fraction thereof, 3a the cubical eontents thereof with the miaimum of $4.00.
For Che purpose o��comput3ng fees for buiZdfng permite, the cubical contenta
of any building or addition to a uniform height throughout by multiplying the
grouad area covered frc� a point six (6) inches below the floor 13ne•-of the
basement or cellar to the average height of the upper surface or to the average
height of the roof surface of the main gable of a,pitched roaf. .
2` 5. For:repa3rs or.alterat3ons to an existing.structure, the,fee shall
be at the rate:of�$3.00 per e�ch E'ive Hundied Dollara, ($5p0.00) or fraction
thereof in the cost of all proposed work. �
2.6. In no case ehall the fee charged for any permit ag aet forth in
Section�-be less th.aa $4.00.. . �
STORM REPATR DAMAGE FEES:
Reeidential;
Co�ercial;
��
Eatimated Coet of work up to $500.00 -$5.00
Estimated Cost of work over $500.00 •$10.00
Esti.mate�at of wo�k��p to $500.00 - $1Q�0
Betimateo ,ost of work over $500.00 -$2(._ J ��,
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CHIM�JEY AN�J STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes (,)
2. Is free from rust or deterioration Yes (/ )
3. Has no foreign objects lodged within Yes ()
4. Is securely supported Yes ()
5. Meets alT �urrent Code requirements for size and
total BTU connected
6. Has To tal hea ting BTU's of
All other BTU's
TOTAL
Rema rk s
Com pa ny
Signed By
Da te
No ( )
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No ( )
Yes ( ) No ( )
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CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes (,)
,
2. Is free from rust or deterioration Yes ()
3. Has no foreign objects lodged within Yes ()
4. Is securely supported Yes ()
5. Meets all _current Code_re_quirements for �i��__and
total BTU connected
6. Has Total hea ti ng BTU' s of
Al1 other BTU's
TOTAL
Rema rk s
Com pa ny
Signed By
Da te
No ( )
No ( )
No ( )
No ( )
Yes ( ) No ( )
SUBJECT
c�ty of Fridley 2 0 5 5 2
, , AT THE TOP OF THE TWINS g � I L D I N G P E R M i T R NO
r
� � COMMUNITY DEVELOPMENT DIV.
� �.: ------. 3 77/ �'
� � � PROTECTIVE INSPECTION SEC.
� � �
i---- � �r'�',•� CITY HALL FRIDLEr 55432 NUMBEF REV. DATE PAGE OF APPROVED BY
L '� 612--571-3450 910-F15 �/5/90 � �
J08 ADDRESS 6895 Channel Road N, E,
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. P't. 2 Brookview Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Lyle Quazn 6895 Channel Road N.E. 574-9536
3 CONTRACTOR MAILADDRES5 21P PHONE LICENSENO.
Top Gun Roofinq 9644 Ximines Lane� Maple Gr,ove, N�] 55369 425-1444
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO.
5 ENGINEER MAILADDRESS IIP PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION O ALTERATION C� REPAIR O MOVE ❑ FiEMOVE
8 DESCRIBE WORK
Re�oof Dwelling (tea,r-of�) 25 Squa,res
9 CHAN(iE OF USE FROM TO
-STIPULATIONS
On all new roofs or tear-offs and replacement roofs,
State Code requires t��t 2 Ia�ers of 15 Ib. felt,
m�pped together, he insiailed io a point 24 inches
up from exterior w�li line, or the use of other
approved underlayment membrane.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WOHK 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 STAILS 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 $1 �25Q - �` a(�
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 F ANY OTHER STATE OR LOCAL LAW REGULATING CON- �•31, QO.
STRUCTION THE PERFOF;MANCE CONSTRUCTION.
. `� AN CHECK FEE TOTAL FEE
�'-- �-�n F`. e SC l. 25 $32. 88
SIGNATURE FC � ACTORORAUTHORIZEDAGENT �onrEi _' HEN PROPERLY VA T D THIS IS YOUR PERMIT
� � J �' ��l
SiGNATUREOFOWNER�iFOWNERBUILDEP� iDATEi BLDG �NSP �ATE
NEW [ J Effective 8/16/90
ADL1�T [ ] 1�1 AND R-2
ALTIIt [ ] Buildir�g Piermit Applicatioa�
Construckion s'''' • �: %/ � � � � � c, � /! i- / %�C/ -
Legal Descriptiari:
owner r�ame &���: L y i� � u�,�r. sa�a �� z�e1.. # s ��-�-�"� �
�, � _
Centractor:
�. # �/�s iy s �
�i��-u.S' /i"�_ L T C� � 1 � o /�'� ,� � tot . � ��Y! � (9 �'Dv � /'� �t � SJ^ � � �'
Attach to thi.s application, a Certificate of Survey of the
lot, with the pro��ased �ioaz drawn oai it to scale.
�.:�_ «; ��M •;, . _
LlvndG ARII�,: Ierigth width xeight sq. Ft.
GARAGE Ait�i: Length Width Height Sq. Ft.
D�CK ARE�i: Tp*�h Width Hgt/Grauxi Sq. Ft.
�' � � � -- �s� v'D �'�' � S
.
(brner 7�t [] Inside Lot �[ l Ft. Yd Setbaak Side Yard Setbacks
Zj�pe of Construction: _�s���./,� s�,' l�s° Fstimated Cost: $ �� �� ��'
Ap�rox. �letion Drate: � ��S"d � � •
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
+ 6' See Back Page
L1ATE: � �' % o APPLICAN'I': \ Tel. # ��-%r'3'- /��`S�
P2rmit Fee $ ��• �G
Fire S�rcharge $ /_ � ��'
Statg S�mhati9e $ �.3
SAC Criaxge $
Driveway Escrow $
Park Fee $
S�wer Main CiiaYge $
• v=_,
sr�x.rr.�,ZZO�s:
$ ��. c��
��, C� �
CITY IISE �Y
Fee Schedu7.e an Reverse Sic�e
.001 x P+exmit Valuatioa'i (1/lOth �)
$.50/$1,00o valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined bY �l��9
Agr�ner�t NecessaYy [ ] Nat Neoe.ssaYy [ ]
On all new roofs or tear-offs and replacement roofs.
�%�� v State Code requires that 2 layers of 15 Ib. felt,
mop�ed to�ether, be installed to a point 24 inches
up from exterior wal! line. or the use of other
approved underlayment mem�rane.
��
:�1 A� � •':�i•J � '��i° : N:I�i� 1 '
�e Ctiief Bui.lding Official shall, before issuing ��+;ts for the er�ectioai of ariy
�; i dirig or structure, or for ar►y addition to ariy existing building or structure, or
for any altexation or repair to ar�y existirig building or structur�, upon application
therefore, require.the payment by the applicant for such ��;t of fees to the amo�nt
herein below set forth and in the maivier herein prwided ta�ait:
� TO►I'AL �TAII7E
$1 to $500
$501 to $2,000
$2,001 to $25,000
�25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
M�+��.�
$15 (Minim�un Fee is $15 plus surcharge)
$15 for fizst $500 plus $2 for each aclditic�nal $100 or
fraction th�f, to and iricluding $2, 000
$45 for first $2,000 plus $9 for each additional $1,000
or fraction thereof, to and including $25,000
$252 for first $25,000 plus $6.50 for each additional $1,000
or fraction thereof, to and iricludirig $50, 000
$414.50 for fisst $50,000 plus $4.50 for each ad+ditional
$1,000 or fraction thereaf, to and iricl� $100,000
$639.50 for first $100,000 plus $3.50 for each additional
',$1,000 or fraction thereof, to ar�d including $500,000
$500,001 t.o $1,000,000 $2039.50 for the fixst $500,000 plus $3 for each additional
$1,000 or fraction thereof, to ar�d including $1,000,000
$1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for each additional
$1,000 or fraction thereof
DRIVE'f�Y DEPRESSI�T ffiC[�O�W
(Cbricrete Cu.rb Streets On1Y)
Alternate "p,��: Remvval and repla�nent of curb and gutter only - Driveway width plus
6 feet ti.m�s $13.50.
Alte,rnat� "B" : Remaval arzd replac,ement of cur% and gutter and in.stall a 3 foot wide
approach with 6 inch depth - Drive�ray width plus 6 feet times $15.75.
'I�+;_ ��_ �• •� • r • �i u • •�
P�er�mits for oorLStruction will be issued a minina.ua of 24 haurs fraan the time of
applicatian t� allaw for propPS review of the proposed structure ar�i of the
aonstruction site.
A Certificate of SuYVey of the lot, shawing the location of the f�ation once it has
it has bee.n wnstructed will be required before proc�ed�rig with the framing.
..,,
Building
Inspections
763-572=3604
�ATE,��
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
' � . u t M_ M_/ . .
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATIOI�T
CITY OF FRIDLEY
PHONE: /b� ti7 ^
NAME:.�1
STATE LICENSE #
EXP DATE
'- �• �, _+ `+_
� - - - . : ��\
.
.__; �- . �
ADDRESS: CITY S1'ATE ZIP
PHONE
Y/NEW
❑ BASENIENT FWISH
❑ DECK
DESCRIBE WORK BEING
STZE OF
xuvr��.
NUMBER OF SQUARES �
GARAGES
PROPOSED SIZE:
PROPC?SED J�IGHT:
SIDIlVG
❑ V'myl
O Aluminwn '
❑ Odter . •
FAX
�TRUC1'ION
.UCTION
❑ GARAGFJSHE]
�Iit�F
' CTSIDING
❑ SWIIvBviD�iG Pt
� HOUSE & GAR.AGE
❑ ATfACHED GARAGE
❑ DEfACHED GARAGE
�Soffit
0 'frim
❑ Fascia
WINDOR'S `
It� EXISTIl�iG OPENAtGS �Yes CINo I.�A170N OF WD�iDOWS
OR FORNEW OPENINGS-DESCRIBE ST7_E OF
OPENWG CHANGES 8c
❑ DRA1N T[LE
❑ 077�R
i�� 1
BASEMENT REMODELIATG SUBMiT•
1. Existing Fioor Plan
2. Proposed fl�r pfan
3. List of structvral members m be used
Ft
FOR NEW CONSTRUCffON IIJCLUDING DECKS,
ADDITIONS. & PORCI-IES SUBMTf•
l. Site Plan/5urvey showing the existing swc4ues
and proposed project.
2�. Two sets of const�vction plans
3. Energy Calculations
TYPE OF WIt�TDOW TO BE WSTALLED NUNBER OF WWDOWS �
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $__ _��j�p OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Swrchazge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosiott Control
Park Fee
Sewer Main Charge
Total Due
$
$ ��
$ /.�3
$
$
$
$
$
$
See Back Page for Fee Schedule
65% of Building Pemvt Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1675 per SAC Unit (Plans to MWCC for determination)
ft+6ft= 8x$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: Citv of Fridlev Attac
THIS IS AN APPLICATION FOR A PERMIT NOT YALID UNTIL PROCESSED
I hereby apply for a building peanit and I ac�owledge 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 rmi 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 work s r ie approv of plans.
SIGNATURE OF APPLICAN7' p�.(T N r /
Page 2- Bui.ldi.n.g Residential Application
BUII..DING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or
shucture, or for any ad.dition to any e�ci.sting building or stru.cture, or for any alteration or repai.r
to any existing building or strucivre, upon application iherefore, require the ,payrnent by the
applicant far such permit of fees to the amount herein below set forth and i.n the manner herein
provided. to-wit: �
VERIFICATION OF FOUNDATION
Permits for constxucti�n will be issued a minimum of 24 hours from ihe i,ime of application to
allow for proper review of proposed. structure and of the construction site.
A Certifica.te af Survey of t�e lot, showing the location of the existing found.a.tion will be
required before proceedi.ng with the firaming. New Houses Onlv
City of Fridley
Buildi.ng Inspections Depariment
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977