AF - 47637CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
�-----`4 ,,,—.
PERMI Np.: 2004-01592
DATE ISS . �tI4/2004
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 5298 JOHNSON ST NE
PIN : TOQ0061
LEGAL DESC : HORIZON HEIGHTS
: LOT 1 BLOCK 1
PERMIT TYPE : BUILDING
PROPERTY TYPE : INSTITUTIONAL
CONSTRUCTION TYPE : NEW CONSTRUCTION
VALUATION : $ 1,000,000.00
NOTE: SEE NOTATIONS ON PLAN.
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. REPLACE 1.5 MILLION GALLON,
PRESTRESSED CONCRETE, WATER STORAGE TANK (74'6" DIAMETER).
APPLICANT STATE SURCHARGE, VALUE 500.00
NATGUN TOTAL 500.00
11 TEAL RD PAID WITH CHECK # 123435
WAKEFIELD, MA 01880-
OWNER
CITY OF FRIDLEY
6431 LTNIVERSITY AVE 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 construction
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 ive authority to
violate or cancel the provisio of any o r state or local law
regulating constru ' n or th perform c of construc ion.
Applicant Date
Bldg Ins D � �
SEPARATE PERMITS REQU D FOR WORK OTHER THAN DESCRIBED ABOVE.
08/30/04 0N 2:58 RAX 7$1 224 5153 NATGUN l�Op2
,� L�I I Y OF F�IDL� �+
6431 Un�versityAveNE R-3lCOMMERCIAL,/INbUST1�iAL/pi.1BLIC/INS�'�'�'�pN,�, I�1/2bo4
Frid�ey, MN 55432 BUII.DING PFRMIT pppl.ICpTiON
(763) 572-3604 FqX (7'63) 57�-1287 �a9� � o�/v�Q - 1 '� 6�,� r w D l���
�(J
CONSTRtJCTION ADDRESS Zoning
Lega1
Owner & Address .. !� Tel# (�) — y
CoNTRACTOR & ADDRESS ,���/ �p�Q�lc1L, _rel# (�i ,_
� �at � ��r� �/�'�l
A�chit2ct Reg.# Engineer�' � �y, ��Re�.#
BUiLDING COMSTRUCTION
TYPE OF WORK � New [) Addition [J Alteraticn -pescribe
OFC. AREA: Length Wid�h Height � Sq. Ft.
WHSE AREA: Length �_ Wiath Height �_ Sq. Ft._i,
OTNER AREA: l,ength � Width Height � Sq. Ft..���_
'D.oad��r d 7r!' � d '•
APP�ICANT c Tei # 7;�;���� pate
UALUATION
Sq. Ft. � x; Cost/Sq. Ft, = U�luation S�}
Sq. Ft, �^ x y� Cost/Sq. Ft. = Ualuation $�) - s T ' ?�
Sq. Ft. x E____` Cost/Sq. Ft. = Ualuation f�) TpTAL UALUE
������ �-� /�
Building Us Construction T e- "' `'
YP Occupancy Graup .------
Air Condittoning []Yes��No Fire Protectian Provided [�Yes �No
Performance Bond Amount c� See Reverse for S�heduie Receivpd []Yes CJNo
PERMII' FEES
Permit Fee
Plan Check
Fire 5urcharge
� /S!
� .��1 /�
5
State SurCharge �
SAC Chsrge ; � �
Erosion Control �
Park Fee E
Spec. Assessments i
Curb Cut Escrow S
TOTAL �� � �
See Fee Schedule on Reverse Side
65Z of 8uildin9 Permit Fee
.001 x Permit Ualuatioh (l/lOth X?
5.50/51,000 Valuation (See Sched. for > 31 �qillion)
31350 per SAC Unit (P1ans to MWCC for determination)
5450.00 Conservatiort Plan Review
Fee betermined By Engineering
Agresment Necessary [j Not Necessary (j
feet x �/foot
ATTACH STIPt1LATI0NS
i��������' ✓�� �t Z � L���C T� �
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08i30!09 MON 12:57 FAX 781 224 5153 NATGLiN C�OU1
-�-
11 Teal Road, Wakefield, MA 41880
FaCSI '
�n tle
Reference: Water Storage Tank Project
To: Joh� Haukass
City of Fridley
Phone: (763� 572-3sao
Fax: ns3ti_—_��-°:�
REMARKS:
� John,
Date: g/30/2004
Number of page� fncluding cover sheefi 2
From: Michael Dufresne
Phone: 781-224-'5183 4
Fax: 781-224-5163
❑ Urgent ❑ For your review ❑ Reply ASAP ❑ Piease cornrnent
Attached is the Building permit for the Water Sto�age Tank replacement project. Please let mQ
know you need any turther informativn. I can be reached at the above number.
Thank you,
Michael Dufresne
Facsimile copy on
Hard co to follaw via U.S. Mail.
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