AF - 36532Caty of Fridley, Minn.
BUILDING PERMIT
� �� �
Date: ..�-; �
Owner: �F � � . Builder .
AdBress
Address
�.�
N° 586'7 .
LOCATI UILDI�lG �
No. . Street � � ` � - .��r'�"`_-�.-•� Part t
,�,���. � ,� �
Lot �- Block ddition or Sub-Divisio ..�� `'��
s��� r��
Corner Lot — Inside Lot 5etback Sideyard ��,. �'
Sewer IIevation _._._ ._._ Foundat3on ElevatYon '
DESCRIPTION OF BUILDING
To vsed �� �
.�, ,,�
�� Front _-�,� DePth Height �� Sq. F� �' Cu. Ft�.,�.._:. �_
� , . • �� �
J� p�,• �' Fron �F� �P� � � � � eight '�". �'.d S F� ,���' Cu. Ft
4•
7�pe of �st�.iction Es�.`Cc s.,�� �" r'�" fio b e C o m p l e t e d
In consideration of the issuaace to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with a11 provisions of
prdinances of the city of Fridley.
.��__._
In conaideration of the_paymeni of a fee of $��`�•, P�t � hereby granted to
to construct the building or addition as descxibed above. This permit is granted u�n
the express condil3on that the person to whom it is granted and his agents, employees and worl�nen, in all work
done in, around and upon said building, ar any part thereof, shall conform in all respecta to the ordinances of
r^ridiey, Minnesota regarding location, construction, alt�ration, maintenance, repair and moving of buildings
yvithin the city limits and this permit may be revoked at any time upon violatioa-c� any of the proviaions of said
ard3nances. � .�' r 1i.f'� r �
gu3laing Inspector
NOTICEz
'I6is psrmit do� not eover t6e eonstruetioa, tastaqa8on foe wirieg. Plumbing, gaa 6eatPag, aewer or water. ee suro to see
fhs Build6� laspeetor for ssparate permita for �hese item�.
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APPLICATIt?N FOR BUILDIRIG PERNL[T
CITY OF FAiDLEY, MINNESOTA
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No. � Street
LOC�iTION OF BUILD7.�1G
of Lot
Lot Block �'" Addition or Subdivision�
/ , s .,
Corner Lot Tn.eide Lot /� Setback �, �Side-Yard S�' ���' �
�EC�ER SLEVAT�ON � P'OU�]bATI01V EiEVATT0A1 �7 '��
Applic�`attach to this form Two Certificates of Survey of Lot and proposed
buildiag location drawn on theae Certificates.
DESCRiPTION OF BUILDZNG
To be us ec� as :
_ .�,r " �, ae /
� 6�� � , Front m � Depth� �i�eight� �
Sq. Ft, Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type vf Canstruction �,,,� �_ Eatimated Goat �� �� ���°�
. �. _ . �
To b� Completed
The uadersigaed hereby makes application for A permit for the work herein
specified, agreeing to do a�.l �ork in strict accordance with the City of
Fridley Ordinancee and rulings of the Departmeat of Buildings, and her�by
declarea th�t all the facts and representaCions stated in this application
�re •.,,,,,� e.,a ,..,,.,.e.. *
DATE
(Schedule of Fee Coets can be found on the Reverse Side).
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BO?x,DING PE$M�fi 1PBE �G1�E1�UifL
3eGtion 2. The Inspeator o� Btaiid�a�s s��i�., �w�ore issuing any pes�a�.t for
the e+ecCion of eny buildi�g o:: structus�e, o� f�r any addition to anq exiet-
tnq building or structuxe, or for any alterat9.osne -or repa3rs to any esis��.ng
�bui9.d:iag or sic�uc�u��, upo�i applicativn thereiccsr, xequire the paymen� by �hP
��p1:�ar�nt for aiich permi.t of feea .to tlae a�cu��: iaer.ein be�ow set fosth and
ia t�e �r�nne� herp.',*� ;ntovided to�*.�i�:
2.1. �'o�r any sueh permit �or ti�a ex��:�io�n o� au;► fire-proof building, othe�
than a garage�, warehouse, factox��r G!' gx8itl e�.e�'��:or, or for the erectioa of
�ny fir.e-proof addition, fc� si.�n�? ia.r oecugancy, t�� any axistin� building
stia�.l b� ��: tihe rate o� $�..k0 ��x e�c'a one t�cu��n.z�3 r.ubi.c fee�, or fract3.oa
th.ereof, iu st+r. r cttbic�l conten�s e
2.2. �'o!r a�ay s�ch �eanir for �he �rPCti.�g of anq fire-�roof �arage, warehrn3se,
��ct4Tg or �rain ets•�aCor, cr for t�ae erec�::��n o� any fire�provf addit3oear
for siai�,ar accup�.ncy, to �ny existwas� �L�'1d.�.n.�; sha�,? be �t the rate of $],.25
for each one t�:eusaxnd caibic �eet, cl�saibi��'� as °'f��p�ro�f1° by ;�ectiom 502 0�
tt�e T$in�gapolis Sca��.din� Ge�.e.
�I�US�S
2.3. For any such permit fore th� e�ectian Q� �;� n�r.-tireproo� bui3din� other
than e gatage, warehouse, £actory or grain el�vator, o�c aa� non•�i�eproof
sddition, :Eor similas occupancy, to anq existing building - permit $1.00 for
each one th�usaud cubic �eet.
GARAGFS
2.�5. i�os aay such p�rmit £er the erectio*i ef aay non-fireprc�of garage,
- wa�ehouse, fsctoxy o= �rain elevator, or f�r tre e�ec�ioa of a�ay nqn-fireproof
add�tioa, for similar occup�ncy, to anp existing buildiag �r fo� each auch
building dr addiCion -�iaety cents ($0.90� te� ea�h one Chousand cu�ic feet
os f�a�rio� there�f, in the cubical contsnta thereo£ ca3th a minimum of $4.00.
Fo� ti�e purpese of campu¢iag fees for building pesmite, the cubfcal ��atenta
o,� aay t�uilding o� �ad�.t:�on to a un:lform height throu�hout t+p multciplying the
. gr.o�snd ��e�q aovered �rom A poi�t af.�c ;h) iaches 'below t�e flcor line of the
baseman` or Ce�,�,AB' .t,o th3 eVe.*_'�.gE3 1]e3g11� of the up�ax su�:£sacP or gA *_he
�.��e�sge heigb,fi of th� �.o�f surface o£ the main g�.r�.A �sf -s ��t�hecl roo�.
2.5. ,��r repairs a�° al�erations to an e�:is�iug sfiructure, tise fee sha13. be
�t the rat� of $3.00 per each Five iiundred Dollars �$500.00) o� �raction
t�.axeof in the coat of a�.t psogoseci wor.k..
2„6. ?n no case ahall th2 f�e charged fo� aay permit as eet forth im
3ection 2 be less �han �4�Q�1. ,
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Land Pfortnin�
l�tl Surveyiru�
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Civrl fi� Mt�iuipr�!
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Minn�oPo/s 2/.
ENGII�tEERING, INC. M�'°
SUnsef 4•6D6�
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En�irreeriny ---- En9ineers E Sur ve�c/ors ---
cesta„�`icate o,� s�,z�►e �o: ����HA�f� �f��`r��tD�T
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HEAT L�S CALCULATIONS ��� $� C� ;�
�eatherstrip� AS.H.V Conatr�iiaa Aio. Ynsnlation
Guide
F/indows ( Daors Reference ' On� Wall In� Wa,ll Ce�ing Roof F1oor I�,ind How �4pplied
Yes- o Yes-No 19
F1.� Room Length � Widtb ��Height °% i F7•� �//I/ Room Length �..... Wirlth t� I Ieight �
V�indows and Doors-Crackage and Area Windows and Doors-Crackage and Area (�
Widtb Selght No. of ],ineal ft. 6rea �� Wldth Heig6t 1Vo. ot Lineal ft Area
No. ot pane of pane iighta oP crack sq. 1L No. oi De.ne oP Dane lighta oY craok e�i: EL
� C� / / 2 � �-
( � r (� � � .dL V � 4f'
Cocf. Btn Coef. Btn
In6ltration � � �/t� �. y �' Infiltratioa �`� `/t� ,� �a
Glass �� ..5� � �� �. .s`'c� / ���
F.Sp. wau o :F�cp. wall J_� �-1- s Z.
Net esp. wall p C� / Q C� t� � Net exp. wall
Int. wall �-� ��, �
Floor � Z � y�� C� Floor
Ceil. �, "
. Total Btu. � � Total �u.
Itequired sq. ft. E.D.IZ. or sq. ins. W:A. Leader area Required sq. #t E.D.R. or sq. ins. W.A. Lsader area
% Fl,� �-�� Room � Length � Width 2� EIei�ht � / Fl.� Room j Length 7 Width % Hei
VV'mdows and Doors---Crackage and Area � Windows d D�rs-Crackage and Area �
Wid4h Height Na of Lineel ft Area / W1dth Hetght Na o! Lineal iL Area
Na of pane of pane lights of craok eq. tG � No. ot paae of pane ltghta o! crack e9. fL.
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Infiltradoa / O/ �%0 0 � Wiltratioa � f�
Glass a �S"� �,�' � Glass �� ��
Eap. wall �, � �.7 � F�cp. waII -f- %
Net e.ep. wall /�° �� % O Nec exp. wall �
Int. wall In� �vall
Floor �t
Cea7. � Ceil.
Total Btu. U% C� 7'otal �tu.
Required sy. ft. E.D.R. or sq. ins. W.A. Leader ar�a Required sq, ft. E.D.R. or sq. ins. WA. Leader area
Fl. � ��4e.tr �- I�oom � Length / 1..-W�dth Height / Fl.� ��- �1� Room I Length Widtii � H�
Windows and Doors-Crackage aad Area �� �/indows and Doors-Crackage and Area
Wtdth Het�ht No. o! Llneal PQ Area - Width Height Na of Ltneal fA Area �
No. oY pane of pane UghYs of crack eq. YL Na of pane at
,pane Ughte ot crack e4. tA
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In5ltration
Glass
F�cp. wall 1 �°f- �
Net exg. wall
In� wall
Floor
Ceil.
Total Btu.
Required ac�. f�. IE.D.P
Z
;oef. Bta �_
�G� .� � o p Wileration
�p / � Glass
Egp. wall
P
� c� .�'/ p Net ex�. w
_ In� wall
or sq. ins. W.A. Leader are�s
F7oor
Ceil:
Toeal Bt�a.
�G�
F7��
Req-,�ired sq. ft. E,D.R., or sq. ins. W.A. Ixader area
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Btu
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HEAT �S CALCULATIONS �, , s.�- BURMAN COMPANY
dVeat6erstrips Guide Constrndioa Na. Insnlation
Clindows � Doors Refereace ' Ou� Wall In�. Wa11 Ce�ing Roof Floar I�.ind How .4ppiied
Yes—No Yes—IVo 19_
Fl.� ( Room � L.ength / i_�Jidth / Height � Fl.� .6i � Rooan LEngth f Wirlth I-�eight
Winc�ows and Doors—Crackage and Area Windows a� Doors—Crackage and Area � e
Width Hetght No. oY Ltneal f!. t,reu. Wldth Height ,No. ot Llneal fk Area
No. of pane of pane � If�hte ot cra.ck sq. t4 a No. oY pane of D�e liehts ot craok eq: fQ �
G� � p �./ l�' �� � l � l
f � � / � � � .3� / `7
Cocf. Btn Coef. Btu
', Infiltration � 1 �O � Infiltratioa �`/ � �/"� / b � �
Glass � �@ / ��� G]a� � S � / � o
'I F�cp. wau ► �-t- i � � � � Eap. wall 1 � -�° 1 % �
I; Net egp. waI[ (. � I � 1 � � � Net egp. wall � � / � % � �
I I�e. w.all ��, q.�
� Floo: . Floor '
i Ceil. /�' /' 6 / �i� � Ceil. � `� f � � � �
;� Total Btu. Total Bht. O
'' Required sq. ft. E.D.it. or sq. ans. W:A. Leader area Required sq. #� E.D.R. or sq. ins. W.A. Leader area
Fl.{ �-� � Room � Leagth QJidth ' Height � Fl.) Room � Length Width 7 Heighk �
'� Windows aad D�rs--Crackage and Area Window^s and Doors—Crackage and Area
'� Width Hetght No. oP Llneai ft Area Width HeiBht No. oi Llneal fG Area �'
I No. of paee oY pene lighta ot crsok eq. tt. �' A
�, of pane of �� 1lghta oL craok e4. fb
i / � � � � .,a �
� l � �.� � i � /`�
I
i Coef. Bta Coef. T Btu
i Infiltrataon .3 � 0 �� �'j Infiltration � / � � � �
�i Gtass ,� 3 � � � � Glass � �`� �
', Eup. wall / � --�- �� Exp. wall % � �a
' Net esp. wall /.� /�' f.�c� Net eap. wall - �t / C.: / C�
', In� wall In� wall
Floor Floo:
�', ceil. • ��Y �� � ��� c�. �d°.�. J � ��
'; Total Btu. 7'otal �tu.
i Reyuired sy. f� E.D.iS. or sq. ins. W.A. Leader aroa Required sq. ft. E.D.R or sq. ins. W.A. Leader area 0� � e)
', � Fl. � Room � Lsn$t6 ��- Width � He:�bt r� �°l.� Room I I.ength Widtii Hei$ht
'i Windows and Dooxs--Crackage and Area Windows aad Doors—Crackage and Area
i Wldth Hetght iVo. o! Lineal fG Area �(�' Wtdth Hefght Na of Lineal tQ Area
No. oY pane of pane tlghte of crack eq. f� Na oR pane of�yane Iighte of crack sq. iG
� � � � � ��
' Ccef. Btn Coef �tu
��, Infiltratiaa � f6r? � Infiltration
�i Glass cf' ; � / p� Glass
I EEx�. watl (�- $ I st ! l Ex�o. wall
' IVet ea�s. watl �� p �� Net esp. waU �
Int. wall Ia� wall
Floor Floor
' Ceil. � � Ce7:
, Total Btu. Q� �p � To�al Btu.
Required s�. fit. E.D.R. or sq. ina.lil.A. I.eader area Required sq. ft. E.D.R.,or sq. ins. W.A. LEader area
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
i �
i �• COMMUNITY DEVELOPMENT DIV.
r � �' � PROTECTIVE INSPECTION SEC.
� '_ �"'1 � CITY HALL FRIDLE� 55432 NuMeER aEV.
�"'-'� � �'� 612-571-3450 910-F15
J08 ADDRESS 6700 Channel l�oad NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 1 1 Steic�e� .. Texr�,ce
2 PROPERTYOWNER MAILADDRESS
La.rry Petry 670.0 Channel Road NE
3 CONTRACTOR MAILADORESS
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAILADDRESS
6 USE OF BUILDING
Res idential.
OATE
3/31/92
ZIP
ZIP
ZIP
PAGE OF
� �
PERMIT_NO.,
�.24"�
REC�EIPT NO.
�-�� � I
APPROVED BV
SEE ATTACHEO
SHEET
PHONE
571-8079
PHONE LICENSE NO.
PHONE LICENSE NO.
PHONE LICENSE NO.
7 CLASS OF WOHK
❑ NEW ❑ ADDITION ❑ ALTERATION �J REPAIR ❑ MOVE ❑ REMOVE
8 OESCRIBE WORK
Reroof Dwelling (27 �.z�uaa;es) Tea,x-�a��' _
9 CHANGE QF USE FROM
TO
STIPULATIONS
Underla�nent nlust oom�lX� �nrith_. �:tate. Baaild�.ng Code.
TYPE OF CONST.
SEPARATE PERMITS ARE REOUIRED FOR ELECTR�CAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IP CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. • N0. DWLG. UNI1
1 HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VAlUAT10N
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1 �3�.,
WITH WHETHER SPECIFIEO HERE�N OR NOT. THE GRANTING OF A PERMIT F
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERM1T FEE
� PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $35. QO
SIGNATURE OF CON i RACTOR OR AUTNORIZED AGENT IOATEI
� � ���,r�� �- �l 9 �-
!:r��niiioorZfi nu� concnwniFi7RUIL.�ER� IDATEI
OCCUPANCY GROUP OCCUPANCVLOAD
SQ. FT. CU. FT.
OFFSTREET PARKING
STALLS GARAGES
SURTAX
�e %2
SAC CHARGE
k'i:xe SC $1,.43
TOTALFEE
$37�15
:iiLV VAL1DNf�D THIS IS YOUA PERMJT
�
rtEw [ '�
ADDN [ ]
ALTER [ ]
Construction Addre,ss:
CITY OF P'RIDLEY
5INGLE FAMILY AAiD DUPLEXES R-1 AND R-2
Building Permit Application
� �
Effective 3/ 1J92
Legal Description:
Uwner Name & Addres.s: �. �� � � o �' ��,� ��lr �P � %�� Tel. # .5 `7/ ��07�%
e
Contractor:
Address:
,�—
1VIN LICENSE #
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: I�ength
GARAGE AREA: Length
DECR AREA: Length
OTHER:
DESCRIPTION OF IMPROVEMENT
/� �
Width
Wi�h
�Vidth
Corner I,ot [ j Inside Lot i] Ft. Yd . Sexback _
Type of Construction: d
Approx. Completion Dat�: � - .
Driveway Curb Cut Width Aleeded: Ft. + 6 Ft =
Height
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Side Yard Setbacks
Estimat,ed Cost: $ � �3�
(Cost on Back)
Ft x $ _ $
DATE: 3'�/ APPLICANT: ��G�� � Tei. #
Permit Fee $ � � � UD
Fire Surcharge $ /, �/�
State Surcharge S • � a
SAC Charge $
License Surcharge $
Driveway Escrow $
Park Fee $
Sewer Main Charge $
TOTAL
� .3�?.i�
�TY USE ONLY
F� S�hedule on Reverse Side
.001 of Pemut Vaivation (1/10th%)
$.50/$1,000 Valuation
$7� per SAC Unit
$5.00 (State Licensed Residential Coniractors)
Ait. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ i Not Necessary [ l
STIPULATIONS: _
�,�. -
BUII.DIN(i PERNIIT FEE SCHEDULE
The Chief Building Q�ficiai shall, before issuing permits for the erection of any building or structure,
or for any addition to any existing bnilding or struct�e, or for any alteration or repair to any existing
building or structure, upon application therefore, require the paymem by the applicant for such permit
of fees to the amount herein l�low set forth and in the manner herein provided - to-wit:
TOTAL VALUE
$1 to $540
$501 to $2,0�
$2,001 to $25,0�
$25,001 to $50,000
$SO,OQi to $1(�,0�
$lIX?,001 to $500,�
$500,001 to $1,000,�
$1,004,(JOl and up
�.�
$15 (Minimum Fee is $15 plus surcharge)
$15 for first $SU(? plus $2 for e�ach additional $100 or
fracrion ther�f, to and including $2,000
$45 for first $2,000 plus $9 for each additional $1,000
or fraction ther�f, to and including $25,000
$252 for firs�t $25,0� plus $6.50 for each additional $l,(�0
or fia.ction tttereof, to and including $50,000
$414.50 for first $50,� plus $4.50 for each additional
$1,000 or fraction thereof, to and inclading $100,000
$634.50 for first $1W,OOQ plus $3.50 for each additional
$1,(�0 or fiaction ther�f, to and including $500,000
$2039.50 for the first $5�,� plus $3 for each a.dditional
$1,(l00 or firdcbion ther�f, to and including $1,(�0,000
$3539.50 for the first $1,�,000 plus $2 for e,ach additional
$1,�0 or fraction �thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altetnate "A" : Removal and replacemem 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 faot wide
approach with 6 iach depth - Driveway width plus 6 f�t times $15.75.
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 the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the l�adon of the foundation once it has it has been
consttvcted will be required before pr�ing with ffie framing.
-- -� �
Building BUILDING nermit rlo.:�� b� �� ��
Inspections RESIDENTIAL APPLICATION Received By: `''
763-s�2-3604 CITY OF FRIDLEY D °��
763-502-4977 FAX �� � �
EFFECTIVE 1-1-ZO10
DATE I�� 7�� I O YOUR E-MAIL ADDRESS
SITE ADDRESS � l� D C(�ia r v� ' :��
THIS APPLICANT IS: �WNER �CONTRACTOR
PROPERTY OWNER/ NAME: /� /Q�� ��"T� rJ'
TENANT ADDRESS: 4%l� `' �-�zuv�.+� �� CITY �l� t( L� f°' STATE�%r./ ZIP J�°y`��
PHONE: ��� � 7c+ � l G� �
CONTRACTOR N,�:
SUBMIT A COPY OF STATE LICENSE #! EXP DATE
YOUR STATE LICENSE
AND CERTTFICATE OF ADDRESS: CITY STATE ZIP
INSURANCE PHONE FAX
PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCT[ON SIZE
❑ TWO FANIILY/NEW CONSTRUCTION STORIES
PERMTT TYPE � �DIT10N ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FIrTISH �OOF ❑ DRAIN TILE
❑ DECK ❑ SIDING � OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION
MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BIING DONE:
SIZE OF IlVII'ROVEMINT LENGTH WIDTH HEIGHT S FT
1tOOFING 0 HOUSE ONLY BASEMENT REMODELING SUBMIT:
NIJMBER OF SQUARES� �f-IOUSE & GARAGE 1, Existing Floor Plan
GARAGES ' ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACIiED GARAGE 3. List of sUuctural members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl �Soffit ADDITIONS_ & PORCHFS SUBMTf:
� Aluminum ❑ Trim 1• Site Plan/Survey showing the existing structures
� Other ❑ Fascia and proposed project
2. Two sets of construction plans
WINDOWS . 3. Energy Calculations
IN EXISTING OPENINGS DYes ❑No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND
OR FOR NEW OPEAIINGS-DFSCRIBE SIZE OF MANUFACTURE STICKER ON WINBOW.
OPINING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BAS�D ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee $ See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ ;� d�_ .001 times the total job valuation
Surchazge $ g��j .0005 x Permit Valuation Minimum $.50
License Surcharge $ ' $5.00 (State Licensed Residential Contractors)
SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft + 6 ft = fi x$24 =$
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Detertnined by Engineering
Sewer Main Charge $ Agreement necessary () Non Necessary ()
Total Due $ G� �'� Make checks uavable to: Citv of Fridlev Attach Stiqulations
THIS IS AN APPLICATION FOR A PERNIIT-NOT VALID UNTIL PRQCESSED
I hereby apply for a building permit and I acknowledge 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 understa.nd this is not a
permit but only an application for a permi and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of 1 work whi h�e es •'ew and approval of plans.
SIGNATURE OF APPLICA ��`-�� PRINT NAME ""/�'�� fZC �. I�o` DATE /�� I�(G i O
Page 2- Building Residential Application
BUILDING PERMIT 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:
TOTAL VALUE FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $]00 or fraction, to and
includin $2,000
$2,001 to $25,000 $6925 for 1�` $2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$25,000
$25,001 to $50,000 $391.25 for 1�` $25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1� $50,000 plus $7 for each additional $1,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1� $100,000 plus $5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,000 or
fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 for the 1" $1,000,000 plus $3.15 for each additional $1,000 or
fraction
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
Fridley, MN 55432
763-572-3604
Faa�: 763-502-4977