P - 44201CITY OF FRIDLEY
6431 University Ave NE
Fridley MN 55432
(763) 572-3604 FAX (763) 571-1287
Job Address:�_
Legal Description:
Owner & Address:�
Contractor :�j G �
Address : C.�'�"(
� / + .~
MOVING [ ] DEMO �] PERMIT APPLICATION
°<� � ��:; �� ("L�,�.
DESCRIPTION OF
HOUSE: Length Width Height
GARAGE:Length Width Height
OTHER• Length Width Height
State License #
Estimated Cost $ Z 3�pC�c�C,�C� Approx.
CALL GOPHER STATE ONE AT 651-454-0002 FOR
uT�LITIES FOR DISCONN�:CTS BEFORE WRECKING/MOVI
Movirig Route:
AppROVAL(S) REQUIRED PRIOR TO ISSUANCE:
1�CA: NOTIFICATION OF INTENTtTO
�llect [ $
�itions
'�� �
�i ions
g 2010
#
# � t.?4!�
Sq. Ft. Cu. Ft.
Sq. Ft. Cu. Ft.
Sq. Ft. Cu. Ft.
Campletion Date S -�.�'" �T �'�
�.,�,^( G'�s,.'�' �C.�. 'adt C7
UTILITY LOCATIONS. CAI�L ALL
��,_ . U � .
JSignature
/
`� �y�� � 7"� .
�--; i�.��
rr�,�� a�c.r ,��-��. � �a-r� s��, )�.��►��r���s
O��t; �7z_ 3, 6�
l7,� LlQS �I �2.
�/.� � A � � ��1ZJ
Conditions
The undersigned hereby makes applicarion for a permit to wreck/move the building described above, agreeing to do all work in strict
accordance with the City Ordinances and rulings of the Building Division, and the State Code which requires any water well on the
property to be sealed by a State licensed water well driller, and hereby declares that all facts and representations stated in this application
are true and correct.
ALL DEMOLTTON DEBRIS, INCLUDING FOUNDATION & SLAB, SHA�. BE REMOVED FROM SITE.
���3�2a��
Date
. �� �
signature
Movin
Principle building into Fridley . . . . $300.00
Accessory building into Fridley ... $ 42.00
Through or within the City ......$ 20.00
Move a building out of City ...:..$ 20.00
PERNIIT I+'EE: � � �� �
Wrec '
For each 1,000 cubic feet or fraction. .....$1.25
For structures which would be impractical to
cube, the fee shall be based on the total cost
of wrecking at the rate of $6.00 for each $500.00
or fraction. _
MINIMt7M $20.00 Office Use Only: SAC-D form completed
Effe�tive 1 /O 1 /2010 ����i�,,.f � �"�' ��'�, -z� / �' �' j; �
v''l. � - 4�
� 4
Date:
A�ddress:
Projec�
Contractor.
Fire Department Building Demolition Review
September 29, 2010
7675 Madison Street, N.E.; Fridley Medical Center
Demolition of former medical clinic
Sauter and Sons, Inc.
Contractor shall be familiar with this review document and contents prior to initiation of work. The
condihons contained herein shall be considered as requirements for the proposed project A written
response or additional documents may be necessary and are due prior to initiation of proposed demolition.
You may contact the Office of the Fire Marshal at (763) 572-3621 for additional inforn�ation.
1. Provide this office with a copy of an approved Minnesota Pollution Control Agency Notification of
Intent to Perform Building Demolition prior to initiation of demolition. This copy rnay be transmitted
byfacsimile to (763) 502-4983.
2. Regulated hazardous matexia]s identified or discovered on or in the building during pre-demoliuon
assessments shall be abated prior to proposed demolition and disposed of properly. Disposition shall be
compliant with rules, laws or guidelines promulgated by any local, state or Federal regulatory agency.
3. All demolition activities and waste disposal for the proposed project shall be performed in accordance
with 2007 MSFC Chapter 14 and applicable provisions, 2000 NFPA Standard 241, applicable Minnesota
Pollution Control Agency guidelines with respect to building demolition and waste disposal.
4. Dumpsters or waste containers placed to contain combustible demolition waste shall be placed away from
the building a sufficient distance to prevent an e�osure fire from dumpster or container contents on or in
anybuilding on the demolition site or adjacent property.
5. Identify, secure and verifyternzination of all utilities prior to initiation of demolition activities.
6. During demolition activities, contractor shall secure building and site by boarding, locking, blocking or
other protection to prevent entry by unauthorized persons. (2007 MSFC 311.2.1)
7. Following performance of the proposed demolition activity and removal of demolition debris from the site,
an inspection shall be performed bythis office to assure proper completion of the permitted work
Project Submittal Reviewed for applicable Code Coxnpliance byRalph Messer, Fire Marshal
�
�u`�jeCt
•_lnsa�
,0�� �
/� Date
To Fin�
�ct�on_