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AF - 41975City of Fridley, Minn. BUILDING PERMIT � � � .: - , , � �' . � , /� ..s � J !! .i �� . � ..."'/1, .. . , �. -�� 1�T° 6171 ,,� � � �O� ��,�+'',f LDING Na Street - �--�L��a� ,. � --�-, �--�- p�� Lot '" __ Block �..� Additiaa or Su -Division � ¢ a�''. �; ��° `'� ��' �r Corner Lot _ Ins3de Lot �'"�� Setback ��— Sideyard _..,�� Sewer IIevation ____ Foundation IIevatian DESCRIPTION OF BUILDIIVG To Used � a��:.+:� Front �� Depth _.��r •,R, Height �'�' Sq. Ft ��—� �—�-#�c-'n. P't. �.�-Q� t Depth FTeight ' Sq. Fk ' Cu. F't. Type of Consiructiony�� Fs� Cost �C��...�..�o be Completed � Ea consideration oP the ieauauce to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the d�scription above aet forth and in compliance with all provis�ttons of ordiaances of the dty of Frfdley. � In conafderat4on of the payment oP a fee oP $��"""�permit is hereby graated to to croastruct the building or addition as described above. This permit is granted u�n the express condition that the person to whom it is �anted and hia agents, employees and worl�en, in all work done in, around and upon said building, or any part thereof, shall conPorm in all respect� to the ordinances of Fridley, Minnesota regarding lacation, conatruction, alteration, maintenance, repair and moving of bufldings within the dty ]imits and thia permit may be revoked at ar�y time upon violation oP aay of the provisions of ssid ordinancea �.. . w : �`� Buflding Inapector �voncE: ihb psrmh does eet cover f6s eoe�trueHen, lestallatlon }e� wteta�, �lumbteo, �u h�afie�, s�wu or rrN�r. � wn fo se� tl» Bntidieg lespaetor fee apa►m p��hs fee t6�a N�nn. _ ."'� 5.-.�.� .!1- �.. r-� �'` � , ..� � � A i'"., APPLICATION FOR BUILDING FERMiT CITY OF FRIDLEY, MZNNESOTA 0`acier's Name Builder � � Address Address LOC�TION OF BUII�DING No. Street Part of Lot Lot Block Addition or Subdivision Corner Lot Tnside Lot Setback Side-Yard SEWER Et.EVAT�ON � FOtJNDATI0IV ELEVATION Agplicant attach to this form Two Certificates of Survey of Lot and prop�osed building location drawn on �hese Certificates. To be used as: DESCRIPTION OF BUILDING Front Depth _,_HeighC Sq. Ft. T_Cu. Ft. Front Depth I�eight Sq, Ft. Cu. Ft. Type of Constructioa Eatimated Coat To .be Completed The undersigned hereby makea application for � permit for the work herein specified, a�reeing to do a�.l work in strict aceordance with the City o£ Fridley Ordinances aad ruliags of the Departmeat.of Buildings, and hereby declares that all the facts and representationa atated in this application ase true and correct. DATE (Schedule of Fee Coata can be fouad on the Aeverse Side). �`�1 r`1 � . . ` . a _ BU�DING PERMLT FBE St�E�ULE Section 2. The InspecCor of Bui�;din�s shall, before iseuing any permit for the erection of aay bu3lding or structure, or for any addition to aaq exiet- in� buildiag or .etructure, or for any alterations or repaire to any eacis�ing buildiag or sicructure, upon application therefor, require the payment by the appl�cant for such permit of feea to the amount hereia below aet forth and in the man�aer herein providad to-�iir; • ' 2.1. For any such permit far the•e;ection of anq fire-proof building, other than a garage�, warehouae, factory or grain elevator, or for the erectioa of , any fire-proof,addition, for similar occupancy, to anq eacisting building srall be �t the rate of $1.40 for each one thousand cubic feet, or fraction thereof, in auch cubical contents.. 2.2. Fos any auch permit for �he erection o£ any fire-proof g�rage, warehouse, fac�ory or grain elevaCor, or for the erection of�aay fire-proof addition, for siffiilar occupaacy, to aay exiatimmg build�ag shall be at the rate of $1.25 for each ona thousand cubic feet, classified as 01fireproof" bq Sectioa 502 of the Nlinne�polis Building Code. flOUS�S 2.3. For any such permit for the erection of �ny non-+.�-ireproof building other than a garage, warehouse, factorq or grain elevator, or aaq noa-fireproof add3tioa, for similar occupmncy, to �ny euistiag building - permit $1.00 for each oae thouaaud cubic feet. GARAGFS 2.4. For any such permit for the erection of anq aon-fireproof garage, w�rehouae, factory or grain elevator; or for tre erec�ion of e.ny non-firegroof �ddition, for similar occupancy, to•�ay exiat3ng buildiag or for each auch buildfng or addition - niaety centa ($0.90) £or each one thousand cu5ic feet or fractioa thereof, in the cubical contents thereof with a minimum of $4.00. �'or tt�e purpose of compue3.ng fees fo� building permits, the cubical contents of any buildiag or �dditi4n �0 8 un3form height throughout by multiplying the ground area covered iram a poiat six (6) inches below the floor line of the basemex�t or cellar Co the average height of the upner surface or to.the average height�of the rbof aurface of �the main gable of a pitched roof. 2.5. For repairs or alteraCions to an exie�ing structure, the #ee ahal.l be at the rate of $3.00 per each Five Hundred Dollars ($500.00) or fraction t�iereof fn the cost of all proposed wo�k. 2,6. In no case eha11 the fee charged for any permit as aet forth in 3ection 2�be lesa than �4.00. � �� •= A . '� _� f Lun�'Plannrn� c�ds�ey��y Sa►1s T sfiny Ct�i! b M�midpvl Ern�irreerir� 687'S-H�lin� +6'S �vE. Minneo�w/rs 2/, � ENGINEERING� INC. �n��°�° � SUnset4-606� En9ineers � Sur veyars — certs�icate o� sszsve �o: ,r�•.ia ►.4Na:. — _ _ . — -� � ��°� m I �— . �:. . - �vc��.. ��"3. � �"a�'.Z �.-�� `�`=.'�� ,-�;_ � � � � _-=_ °-= _ ' � _ _ _ _ _ ,_ _--- --� - - --- � c� -r � �� 4 �-, �LC,��. T A ��I�f �t��'1� '�x� - — —_�'k_�� 5---- --- � � �� , a•��a _� �. �, p .._. __ _ <� — — �,�� d � � � � � `� �.�� '�� I/rp�+zby �erfr"�y flmf' �Iris is o Ii�e ar�d mrrecf repnesenfotia� o�'a suwey �'fl�t 6evndor'res �'�e abo�t de�rrn6�d lmad, md g('Nt /' q�'o// dvrldm9s ,lherean , and al/ ris'ib/e r�o»adimmfs , r�'mx�. {ran ar an taid land. As s�rre�ed by me 1lus�- dotf � �`� c� A� �' • SUB URBAN ENG/NEER/N6 , INC. Fsr9rmerrs fr Sur�ors 2�/ �y � � c ��' �_ - ,�.,r; �. _ /�l _ � � � �. ,� — — �y, � � M d � �. � ro r �� d ►� • y : °x :Y : � : ~ . O . a . m �y : t" : � � � N � � � � � � a � �W�x"� � � � � � � � � �° N • o � ��: o . o . o . . Wy : : Q : : 6 O x x � N r � °o q o � � :�9 a y �J` � � � � � z � rt z � z a ; �. � � n �� ' �� J � : O � b a' � � °° �� °' N : �p : .. l�d o : �y' °° : � o • o�► . . � � : : : : . � . : . . : � : : : : �`' O x � � � � � w n� w �... �.. � � C�T p C�j7 O O O � {f3 Efl ifl if! SA {!) � � � O �I � � � ` � Q x � �' � � � � � � � N r � p cD � 0 � � 1'D" � m �/� �I m C r m � � O �� a o �yj � J' � � � g � � � I � ` `. ��`'�� ` : ��1 .:i �i�1 � ■■�� • • ■��, : : ��C � � 8 M R�+ � � � pb �! � � uaiw►�s � �i� SINKS W�, rw�rs FWNT. SHWRS� DRAINS GTCN BtiSINS AUTO WASFIER otis �art, RANOE o�s OPENINGS V i 2 • � > � � � � Q. � � p � �� ,,�� a�o a � � Y3. � �� o � �P �� W b � " � � q�j' m W � Q � M � 'kl �j W o � � � p rf tr' '�, o F � �n y O, i] � � �4 �D �y io a�� `� � � ��y �m�� N � � � M � 3 `� � � ro � � � �� O �p y �°n p � M M �� i ' � � _"* ` � O � � '. d � � m � � � � M � � -Y � o � � A A �V V O m � \ � � � � a � I � :° � N � � � � a p � 0 c[i x �� r � ox y � � tl x x x � � � � o �� M ^ � `+�� N � � o � �E m � </1 ffl � � � L] Y y H � a' �.,. � � � � � � � � � � � o � � ,v�,� N �� O � O ' O � � : : C � � x � �a O N � °c o a � {fl ifl fA � ` � V � r C] b � � �� b � C � � � w z o z z ��, � � m p z � r � � � � N � � � � m = � rn z L (17 � z ,�, � � � � b � � � � � 0 n � A � C] � m �. � ,�� . x� \� � 1 ` �� 1 �" �� M k�� }l � �� \ � � � ,�; ,� , i m � �o a�o � � 0 � O O 0 O O � 0 r � a �o °e � � I w oa Cd m � ;� �'. � M � H � C � �'1 � V1 y � lD . e�D � • �' • E: � �� 0 aw `� `�° x N o � � y 0 0 : � � n ,i �' � � � � � � � �d � � �' � o � o o � e* Q ��:�� y : � ,e� . . e�T: `i � � x � • • o � : ' � � : : � : � � N N � � °o °o 0 0 °o o° <i! f!9 {{� y� .�i {{j � ''yl � m � � z c� ►�! � � , � � 0 � � � �� o � z 0 � � � �i °x M O � � � ,� � � � �' � � � � � �� " � � � � � � R° � o � Q � n � � � g � � � : � � p, � � o a � � � o : ' � d p . . � O p . . . � O . . . � N � � N � o °o o° o° o° iA !A QI► � O � H Q O � o � a. � � R' � z �g � �, y � � �p m � e'1� iZ � � � �. � g ro C �. � �. 0 vO m � z � � i� � a VC � I� � b b � � S m a� �' � � � � w � � � � � ��° � m � R° r�i r0�y o (d� ?d w y e� €'r � � ° � a � � � a � � � a, . . � op : : pG tl . . O : . : N � � � � en o 0 0 p O O p � � � � ��'a W a.a� � b��'� ° y�� p�� a � � � � � � � y d�� b � �. ��° � � d�� Q O ''�' m td�'c� � �-�'w w��'� o�� a��c� ��op p' �, o fD y �� fD ¢� �� O m �ei' �� .� � ��o �� 5' D � i � � T � 2 m C m b M � � � � � c A � V O � �� : ..---� - � � �� ' � O � � �� Q � � � � 0 ;� � � � �� h � � o. - v< A� �• � �. � 70 � � � .'7 � d � �fJ ��%�7/i�•�0'� Compliments of North Central Public Service Co., � �� HEAT LOSS CALCULATIONB ` °r'�N - DEPA TMENT O ILDINGS V I LLAGE Weatherslrips A.S.H.V.E, Construction No. Insulaiion Guide Windows D�rs Reference Out. Wall Int. Wall Ceiling Raof Floor Kin How Y�No No 19ta'� /b— I�i I —.3 I FL Room I Lengtt}�/ Width ,Z/ iHeight / FL I Room I Length idtY3/2 Wind�ows d Doors—Cracka.ge and Area Windows and Doars—Crackage and Area N.fs I 2��'2�N�'� 7.4slI q� f✓ I o�i0 o��1/e IN�� i7./�t /�Yt. - InSl`t�atlon � � — � Glass — o Exp. wall ' O Net exp. wall ,�yi /O ,�.�J y u�. Wau c�g /O O F1�P To� sc�. /i 33 Required sq. ft. E.D.R. or sq. ins. W.A. I.e�ader area 3 Y FL I� Room I Length�? � Width�� / Height �/ Windows and Daors--Cracka,ge and Area No. I olVpaae I o pane I 1Nixhta I oi�� sa it. � CoeP.l Btu InSl'iralion � � d'' � G� s � z �P• � D Net exp. wall �o � � Int wa11 Ce�lling O � �, 11 0 Floor Totat stu. � � /.s 7 Requ3red sq. ft. E.D.R. or sq. ins. W.A. I.eader area � FL I,. ` Room I Lengt:h / Widrh / Height / Windows and Doors—Cracka.ge and Area Width Height No. oY Lineal fk Area No. ot pane o1 pane lighta of crack sq. ft. Z la �- ,� � ' Co�eP. Btt1 Inffitration ,, � � � Glass !� '' f Exp. wall Net exp. �vaII y � � In�. wall c��g �! � ,,�� Floor Total Btu. � Required sq. ft. E.D.R, or sq. ins. W.A. Leader area ��_ Inffi'tration GlaSs Exp. wall Net exp, wall Tnt. wall Ceiling I Floor I Total Btu. shf O's G'0�2i. BtLl l� O � ` -O 7 � i o ca �� '7 /i� r � ,—�1 I�; P'1�. _�"�P�� Length�a�,C� Width ��J � Height �>/ ' �ndows and Doors—Crackage and Area � In8ltration Glass Exp. wa11 Net exp. wall Int. wall �eiling Floor I Total Btu. Caef. Btu '��O c;1� �►�-- � 7 � � v � 7� 7C� Required sq. ft. E.D.R. or sq. ins. W.A. I.eader ar�a, � Fl, m I Length �/Width / Heig'ht / Windows and Doors—Cracka.ge and Area. No. I oPVpane I oYenane I li�hts I of cra� I sa ft. � � � Ccef. Btu Inflltration � � � Gla:ss ° Exp, wa11 j� Net exp. wa]1 /(� � Int. wall ceiling � � F'loor Total Btu. � Required sq. ft. E.D.R. or sq. ins. W.A. Lea.der area sue�ecr PER NO. City of Fridley 12582 AT THE TOP OF THE TWINS g U i L D I N G P E R M I T • � COMMUNITY DEVELOPMENT DIV. RECEIPT NO. � � i Ly -�'��-� // r � � PROTECTIVE INSPECTION SEC. /�� O ' i ' ' /"'1 � CITY HALL FRIDLEV SS43Q NUMBER REV. DATE PAGE OF APPROVED 8Y �""� � ,'� 812-560-3450 910-F15 6 6 74 � � JOB ADDRESS 645 Faismont S 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ] 5 16 T SHEET 2 PROPERTY OWNER MAIL ADORESS ZIP PHONE Kenneth J a 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 6 USE OF BUILDING 7 CLASS OF WORK � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 22' x 24' Garage 9 CHANaE OF USE FROM TO STIPULATIONS p�it issued on condition that lots 15 & 16, Bl. T, Riv. Hgtso will remain under contiguous ownership with lots 13 & 14, B1. t, Riv. Hgts. Provide a hard surface driveway. SEPERAi'� PER�UIlTS REQi.31R�D FOR WIRlNG, HEATlNG, i'LUI�Bti�G �16�� E��tS: SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. WOOC� Fi THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R 1 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. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT yS2 %9$,LjQ ], �OES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISI� NS OF ANY OTHER STATE OR IOCAL LAW REGULATING CON- STRUCTfON OR THE PERFORMANCE OF CONSTRUCTION. � yS`].O.00 � � /+ PLAN CHECKFEE TOTALFEE � ' �f0 �J.1s3J � GNATUREOFCONTHACTOp AUTH AI2EDAGE ID Et � WHEN PROPERLY IDATED THIS IS YOUR PERMIT � " (� � �" SIGNATUREOFOWNERIIFOWNERBUILDERI (DATE) - LDG iNS p E APpLICATION FOR RESIDENTIAL, ALTERATION, OR ADllITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER' S NAME :_%'1E�yN�r� ,� l�% G o,/ BUILDER: S�� " � ADDRESS :_ i�e �}S� F�iilt/yloua i � �T /Y� ADDItESS : �— "�/ � '� �y� � � No:. �`�5� sTREET: �l9�,�r✓/D�v i LOT : /J� , �BLOCK : u � �� ADDITION : �� v�,� vi �,� /��, y �TS CORNER LOTt INSIDE LOT:_��SETBACK: SIDEYARDt Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. _ DESCRIPTION OF BUILDING To Be Used As; �1aRl�� Front:_ �,`�� Depth: ��{' Hei ht: . g Square F'eet: So2� Cubic Feet: K,�o� Front: Depth: Height• Square Feet; Cubic Feet: Z`ype of Construction: ��oo f-�°�/�'lr Esti.mated Cost• fi�� ' �— T� Be Completed: f�-� ' ��ag '� d v % The undersigned hereby makes applicati�n for a permit £or the work herein specified, agreeing to do a11 work in stxict aceordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated i.n this application are true and correct. DATE : �J� /'� � SIGNAT[TRE • e -P / ..._ '_ / . - � .. .. (See Reverse Side For Additional Information.) -- �o�� ° �.� �/�� ,� ,� � .. r-- �- �� fi` L, � �.s �� U � '�'�� o �f � s s �..� d m,� � � a/, �-,�,� � � � /� � , �, �. 1?-� r�, a , ;� ,�r �i� �� '�� /��.� 1� / �iy � . � 3 �.. _ �s . �,� ir -t. � BUILDING PERMIT FEE SCHEDULE SECTTON 2. The Inspector of Buildings shall, befoxe issuing pe�nits 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 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: UNIFOItM 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 Fox the purpose of computing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the ground area covered from a point six (6) inches uelow the floor line of the basement �or the cellax to the average heights of the upper surface or L-o the average.�- height of the xoof surface of the ma.in gable of a pitched roof. For repaixs or alterations to an e�isting structure, the fee sha11 be at the rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in �he cost of a.11 propg�ed �aorke In no case shall the fee charged for any permit as s�t forth in Section 2 be less than $5.00. VERIFICATION OF FOUNDATION NOTE: Permits for construction will be issued a minimum of 24 hours from the time of application, to allo� for groper review of the proposed structure and of tlie construction site. a. • A Certified Survey of the lot, showing the location of the foundation, once it has been constxucted, will be required before proceedin� with the framing. CERTIFICATE OF OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) days prior to tlie use or occupancy of any structure for which a building permit has been issued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. � B. H. BRADLEY CIVIL ENOIN66R AND SURVEYOR 9829 -26'171 AVENUE SOUTH MINNBpPOL18. MINN680TA 88600 724-21N Surusy �r �'/Ofc�i�ce ,��s�ese,v� /o oI �i�l�3( � S� /�G �' 7 �5�°��,�✓�'' : ��s ��F, ��z.e�a�t� �� S'S4/.3..2 l � �a/e /=.�' �� F'��OGY T 51; I hepeby G�wf��'y �h�f f�i�s �.; a�ve r.�r�c.� coa�ect�a�at,��z��v�y o� L ots' �� C !lo J ,(�/oc�€' � �Pt �r�t�l�u� �f�iyrl� � �l�ol� �'�u��,,�iiix��t�, -�r� �r�,��;�_� �i� �� ' f��a�� ,�1��r: �� . ` _ �� irrveyva ��HS� �i((o //88 " v SUBJECT PE . �-�. City of Fridley 15 9 9 9'�� AT THE TOP OF THE TWINS g U I L D I N G P E R r ; � RECEIPT NO. � ; L ______ COMMUNITY DEVELOPMENT DIV. - r � , � PROTECTIVE INSPECTION SEC. � 1 � i � � ��"1 � CITY HALL FRIOLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY �'""� � ,�� 612-571-3450 9� 0-F15 11/6/80 � � 108 ADDRESS 645 Fairmont Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED oesca. 13,14 T Ri.verview Heights SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Martin D. Hilson 645 Fainnont Street N.E. 786-7180 3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION C� ALTERATION � REPAIR � MOVE ❑ REMOVE 8 OESCRBE WORK Install Class "A" Chunney for HTood Burni.ng Stov.e 9 CHANGE OF USE FROM TO STIPULATIONS Provide co�bustion air for existing furnace. TYPE OF CONST. OCGUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 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 $21S �S`.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $7� rJO S RUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECKFEE TOTALFEE �8. �� SIGNATUREOFCONTRACTOROFlAUTH RIZE�AGENT �onTE� WHEN PROPEFiLY VALIDATED THIS IS YOUR PERMIT � G �U S GN T RE F OWNER IIF OWNE ILDERI ID TEI BLDG �NSP % TE 0 0 CITY �F FltIDLCY • Af'PLIC/1TI0'd FOft f'.l:SIOt:t•dTII��_ BUIL[)It,G PERt�ITTS (tJe►•r, iti1 Cer.�Lions, AdcliLions, or Repairs) � 4lJIdER: ,,� p/�i�! � {��o�/� r`IDQRESS: �%�� ,�i�-�.,�v%� ;,�,�/V�: TEL n�0 : � - ��,�o' 0 0 0 [3UILDER: -��g,�-P. ' _, .,• lIDDRGSS: • TCL I1C�: ' Consi;ruction Locati�n ° • STRI:ET NO: STREET: LOT: �� , �� BLOQC: �_ ADnITION: ` ` ^ ,� Corner Lot: Insicle Lot: V SetbacY.: Sideyards: Ap�lican� attach to tliis form tcao Certificates of Suxvey of lot and proposed building location drawn on certificates to scale. , �� c��a�� DESCRIPTIOid OF C�FISTRUCTIOPJ • � � ;�� Front: � Depth: _ Height: � � �' Squane. Feet: (zibic F,eet: Front: Depth: Height: Square� F'e�t: � Cubic I'eet: ' �d� Type of Construction: Estimated Cos�: $ ��.� ,� 3b Be Oor.�pleted: ' � , . � Alt. A Alt. B Proposed Dx'ivewa�f ti3idth If New Opening Is Desired: $' $ . , S�� ite.VERSE SIDE OF SiIEET . �Sie undersigned lieieb�► ma},es applic�ttion for a permiL- fcr the �:�ork� herein specified, agreeing to w.all work in str�.ct accordance ��ith the City of I'ridley Ordinances and rulings of i:lte Department of T3uil.ditigs, and ]zereby declares that all tl�e iacts and rapresentati_ons �tated :,�i this applicatian are true and correct. D.'�T�: � &IGNATUF�:: d� �'d�3 .��.�L __�� Sti��.ulations : � ,-� ` c-�/1'Y�CJ`. � ,, c� �, s� p �.: ,� .- � c�� _ ._}�__ _ . . . .� IIU1L1)Ih1G I'f_ftl1J'I' r[::: SCflf:r�ULE� � , ;laC:'t'x01�� ?.. �'1'I�8 7n�.:��ectc�r, nr �z►��.i��.r��, :::ti:i7.�., t�i:for.c: i.:��.ui��c� ��ennit:; tor t:hc aract•i.on of: �u�y )�u�.J.�l.ir�� az :.i::.-uct:lll:L'� or. �u�.• .�n�� adcli.t:i��n !:o tusy cr.i�t:i.n� l�tiildinc3 or :>LYUCL•ur.r_, cir. i:ar. r�liy .i1.t:cr�iL•ic-,n or. r.cl��ir.�.; L•o •any c>:S.�.t:inc� hui.).di.�i-� or. sL�:ucturc, uJ�c,�l nr��li.c:at.ion thcr.:f.or.c:, r.c:qu.ir.c tJ�c pay►mcr�L• }�y t]�c ar�p].i.c:ant: for. s,uch per.mi.L• o!' fee� to tl�c �nount hcr�.iii b�J.cn�� sc:C Cor.th �ind i.�i tJ�c tnanric�: hcrein ��:ovi.dc:cl t�-�::i.L: • 1JE19 COIJ�`I'1;UC'1.'IOtJ: Sing].c Fami1.y Ilorr.cs and G��-�-�qcs: ;:4.00/7_,000 cul�S.c xeat.. • PLFsF� C1Il:Ci:: 25 i�ercei�t: af buz.lcli.�ig }�e�7ni� iee. ' URI:��:1•;111' �L•'1'P1:5SIOI•2: (ConereL•c Giirb ;L-rcets Only) � ' • Al.tcrnai:e A: Itc:moval and rep].accment of concxetie curb and quL-L-er only; 17riveway c•�idth plus 6 feet• x�:�.5.75 Al.tcrnatc B: Removal and repZacement of concrete curb and . guttcr and iiistall a 3 L-oot ��ide approach �.�iL-h �' ' ,. 6 inch depth; Drivevray �•�ic:th �plus G ieet x$17.85 . � . pn�.1 �� onn� t��ro�.,�nT r or�.. For the puri�se of computi.ng Lees for buildinc� Pezmits,� L-2�e cuvicaZ contents of any buildi.ng or aadition, is deter.zni.ned by rnu1L-ipl.yir�g the ground area cavered from a poS.nt six (G) inches below ihe iloor ]_a.ne of L•he bascment or th� cellar to 'Eiie aver.age heiqhL-s oi fihc •unper surface or L-o ihe average heiPub of the roof. surf:ace of ihe r�ain gabl.e of a pitched roof . �. Fox re�ai.rs or a].terations to an existang stL-�icture, the fee shall be at the rate ..of $3.00 �icr each five hundred dollars °($500.00) or fracL-ion thereo� in tiie cost af all proposed wor.k. . . xn •no case sha�.l tl-i� ��e charqeci fc�z any pennit �s set iorth i.n 5ectian 2 be less � than $?.50 plus $.50 stat�e surcharge. � ' � � � VERTFICATIO�! OF FOUr�IDl�TIOtd 0 NOTE: Permits �or constxuction ��ill be issued a minimiun ai 24 hours from tlie time ot- application �o al.].o�v £or proper review of �.he proposed structurc and oi ihe . �onstruction site. ; , Ii Ceri.ificate � of Survey of the lot, sho�,Ting the location of tiie foundation oi�ce it has been cons�nicted ��till be required k�ef.ore proceedinq with the ir�uninq. �l3TIFTC('�TE nF O�CUPA��C�' nPP��•Catic�n �or a Certificate oi occupancy shail k�e mad;� ten (10) da�►s pri.or to the use or accurancy of any stz.-ucture for ��hich a i�ua.ldi.ng perr,iit ]:as been issued� dIlCI saicl structure s}ia]�1 »ot be used o2- occupied L:iitil a Ceri:�.fic�te of Occul�zne}� has bcen �ssucd. 0 ' . + =i . ' � . • � t-w � � �DDN [ ] ALTER [ ) CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION � � L�� Effective 1/1/2001 (763) 572�604 Bidg Insp Construction Address: �� /"� . �> > , �� J'�� .� �% Legal Description: � Owner Name & Address: � Tei. # 7 Y'%% �v Contractor: MN LICENSE # Address: Tel. # LNING AREA: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: OTHER: Length Width HgUGround Sq. Ft Construction Type: Estimated Cost: $ Uv Driveway Curb Cut Width Needed�� Ft. + 6 Ft =�Ft x$ �� °_ $ DATE: /' I�6 `��v � APPLICANT: Tel. # - e v CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application $- Fee Schedule on Reverse Side -- — $ .001 of Permit Valuation (1/10th%) $ $.50/$1,000 Valuation $ $1150 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] $ BUII..DING PERMIT FEE SCHEDULE � � The Chief Building Official shall, before issuing permits for the erection of any building or structure, e addition to any existing building or structure, or for any allteration or repair to any existing building or stc, upon application therefore, require the payment by the applicant for such pemut of fees to the amount he, below set forth and in the manner herein provided to-wit: TOTAL VALUE $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 $500,001 to $1,000,000 $1,000,001 and up FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,� $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,0(}0 $391.25 for first $25,(�0 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,(�0 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,�,000 $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,(�0 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Altemate "A": 'Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50. Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $23.25. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. New Houses Only � \ sue�ecT IT City of Fridley 3 25 9 8 � AT THE TOP OF TME TWINS g �� L D i N G P E R M I T r ; � RECEI . � `y �� COMMUMITY OEVELOP�ENT OIV. f � � PROTECTIVE INSPECTION SEC. �� i = � � �"'1 � CITY HAIL FRIDLEV SS132 NUMBEN pEV O�TE P�GE O� �vvqOVED Br �----� • •', 612-571-346Q 9� 0-Ft 5 5/ 15 /02 � � JOB ADDRESS 645 Fairmont Street NE t IEGAL �OT NO. 9lOCK TRACT OF ADDITION SEE ATTACMED oESCa. 13,14 T Riverview Heights SNEET 2 PROPERTY OWNER MAIL ADCR�S$ ZIP PNONE Don Hilson 645 Fairmont Street NE 763-786-7180 3 CONTRACTOR MAILADDRESS 21P PHONE LICENSENO Rite Way Waterproofing 448 Lilac St, Lino Lakes, MN 55014 651-786-0550 4 ARCNITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAII ADDRE$S ZIP PNONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK � NEW ❑ ADOITION O ALTERATION C� REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WOiiK Interior basemen�t drain tile s;�stem 9 CHANGE OF USE FROM T� STIPULATIONS " TvPE OF CONST. OCCUPANCY GROUP OCCUPANCr �OAD SEPARATE PERMITS AFiE RE�UIREO FOR ELECTRICAL, PLUMBING. HEATtN(i, VENTI�ATING OR AIH CONDITIONING THIS PERMIT BECOMES NULL ANO VOIO If WORK OR CONSTRUCTION 20NING SO. FT CU fT. AUTHOHIZED IS NOT COMMENCED V�IITHIN 80 OAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANqONED FOR A PER100 OF /20 DAYS A7 " ANY TIME AF7ER WORK IS COMMENCED ' NO. DWLG. UNITS OFFSTFEET PARKING I HEREBY CERTIFY TNAT I HAVE READ AND EXAMIN�O THIS APPLICA710N 1 S7Al�S GARAGES AND KNOW THE SAME TO BE TAUE AND CORRECT. ALL PROVISION$ OF LAW$ ypLUATION SURTAX AN� ORDINANCES GOVERNING TMIS TVPE OP WORK WI�L �E C(�MPUED @ 1�28 W17N WME7MEii SPECIFIEO MEREIN OR NOT. TNE GRANTING OF A pERM1T y�2,569 $ DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CAMCEL THE pEqMIT FEE SAC CHARGE PROVISIONS OF ANV O ER STATE R CAL LAW REGULATING CON• $83�25 ire SC y+Z.S7 STiiUCT F TN O MA C NSTRUCTION / PLAN CNECK f EE TOTAL FEE � � City ce se 7.10 $iGNGTUAEO�CO • ACTOAOAAUTMON�2EDOGENT �D�TE� EN P OPER IOA� S IS VOUp P RMIT � �"' ` �� S�GNATUAE OF O�hNEA �� OWNEA BU�IDEp� 1� TE� � Bl �NS� ' f�� r NEW ADDN ALTER � J [] t` }� CITY OF FRIDLEY SINGLE FAMILY AND Di]PLEXES R-1 AND R-2 Building Permit Application Effective 3/1/96 ConstructionAddress: (o �-t 5 �a�� S{� �� ; Legal Description: '�� k p,,�,�,� ,��,�,U� Owner Name & Address: � }-� ; ��,� ' Tel. # '�(� 3 - 75�Zo - 7 ��U Contractor: Rite-Wa� Water�roof;nc� MNI.tCENSE# Address: 448 Lilac Street, Lino Lakes MN 55014 Tel. # 651-786-0550 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GAItAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IlVIPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Leng�i Width Hgt/Ground Sq. Ft. �y\ !M1 .. 1 �- / i Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks Type of Construction: �;s}.vyr� Estima.ted Cost: $ oZ S��( .� Approx. Completion Date: � (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: S- � 5- Oa APPLICAIVT: ` Tei. # CITY USE ONLY Permit Fee c�3. �� $�,p ,, _� Fee Schedule on Reverse Side Fire Surcharge� �7 $�, S� 1 of Pe 't Valuation (1110th%) State Surcharge r �� $ j . � � . /$1,0 aluation SAC Charge $ per SAC Unit License Surcharge >( $�X �� p-r $5. 00 (State Licsnsed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Gharge $ Agreement Necessary [] Not Necessary [] TOTAL 37,11� STIPULATIONS: �� .� .� BUII.,DING PERMIT F'EE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addit�on to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require th� payment by the applicant•for such permit of fees to the.amount herein below set forth and in the manner herein provided `to-wi�: ° � , TOTAL VALUE $1 to $500 , $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,OQ0 $1Q0,001 to $500,00� $500,001 to $1,000,000 $1,000,001 and up FEES . . . , $21 (Minimum Fee is $21 plus surcharge) $21 for first $S00 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $349.75 for first $25, 000 plus $9.00 for each additional $1, 000 or fraction thereof, to and including $50,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,�0 $887.25 for first $100,000 plus $5.00 for each additional $1,A00 or fraction th�reof, to and including $50(�,�D00 $2887.25 for the first $500,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,Q00,000 $5012.25 for the first $1,000,000 plus $2.75 for each additional $1, 000 or fraction thereof DRIVEWAY DEPRESSION ESCROW _ (Concrete Curb Streets Only) ' ' Alternaxe "A" : Removal and replacement of curb and gutter only - Driveway widah plus 6 feet times $13.50. Alternate "B": Removal and replacement of curb and gutter and insta.11 a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet 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 location of the foundation once it has it has beeri constructed will be required. before proceeding with the framing. .u'. . e * = � rn '� -` Z � O � � � � � n � � � N� � Q N. � z N � � m �. d m � � � O v h O 0 � O . .0 �' N o+a � � � � _ � � � � o `D � � � a ' �- --- �« � 0 C r+ D � � 0 m fl. W � O C O�q � � v � r+ �D Oq� �� D � �� r �� Z � � m � � � `° � � � m r � � � p� O � v v � m � \ � \ � '� \ • � � A V a°� \.% � 1`•4 � o �3 � e� o, �. C1 N \ m e. _ °, � D 1 � � � n N O � � � � � � iii D m r N m � � m � — °' - � - c� � � � � � �� o � 1 '7 Vl � � � � � � n � c m � m � � ,�-r -�i. �' �D � � a� y om�aa� y W �, fD c. � fl. �. ov � � � o � Q- °° a a. �•vo� .•,• <' °_' 3 � N � � � O N �a 'Q.�� N � � � A y� c'�D �. ='. � o � ��d� m ;°. c��c o � � c. o� `�(1 � � °' -a ,� N y n f�D ,� Q�� 3 c� a� � ,-� r� ° '� � '" � ��,�o CD — S ,�. ,.ny. ? fD �' fD C�i � A � O N O � � a? m � a � m _ _. D r = � Q °, � < `D � � N \ fD (�p � -�i. N D �� -� N 01� � 7 .=r �� O _+; G O � o �' � r � � � Z W n � � � W C � m � � �� a c� � Z �, 1� �, D � n 0 o' � �� ov � N m N G� II� N v � � d d D c � y N ��A 7 � �°-• � � �D = m �,q m d � ci Q' � C � fD � � � � � � Q . > > •�rQ-�7�� —c a �O� � � ? � � C ��o � � n � .��r C � W • v 1 = � � e� t� � tts �► ,cNn o O O o � O O O O O '* cD � � E� � � -� 0 � Z7 W �"� z �-��,o — C � O � --1-� _ _ --� "0 -D � O � � � n � � m � v� m N � � r Z Qrn 0 0 � . �7 � . \ � �.�i �� v m � � D ---I m 0 � O � -� v ` � � � m � � Z O �1 � � � C r � Z G7 c � m v � � m N t'� x rn v C r � ` � o � rn D I� � � � � �� Ut TI d� C7 NQ.W�F-+ � � � � �3�•-n z fD .� ,�p � m w� � N cD Z Z � m� m � � z v C � z � r ma �� O L'f Z m� �O �� O� Z� Z � v� a� �Z Oy vz �v o= Zm Z -�I '� Z �n m� 0 N z v< vm z s� n � N � 0 z � m A < m O � L � 7 C N � N O O O COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When realacina an existina furance, the undersigned hereby verifies that the venting has been examined and is free from n.ist, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No () The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No () The undersigned also verifies that the replacement unit i� a listed assembly and meets the cuRent codes and manufacturers specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. The existina combustion air is sized and installed to meet the current codes and manufacturers specfications. Wfien required to install a new combustion air. it will be sized and installed To meet the current codes and manufactu�ers specfications. Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) When installina a new venting svstem, the unde�signed hereby verifies that it is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. Yes () No () Is the common vent and vent connectors sized and installed correctly after an appliance has been removed irom the common vent and vented separately as per current codes. Yes () No () Apaliance Type and Size/Common V�nt and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) ,��-� �`— HEATING CO: Signed By: Date : Z�-C-� i��"� i1Vit1. lillp UI r11LlOY IU, tVJf ILIU.JJ rQt�+. IfL UQLG. WG.7IGWJI J-`J.eh71 m BU11C11ri� BU�.D��.s Permit No.: Inspections e RESIDENTIAL APPLICATItJN R�IV� By:.� 763-572-3604 CITY OF FIiIDLEY vat6 R�'a: 5�2�-� DATE / YOIiR E-MAIL A�DRSSS 1�� re¢I� .h u el srri AnDx�ss (0�15 f �Qrao.�N� sT �/E THIS APPLIGANT IS: ❑ O�INER �CCINTR�I(°fOR PROFERTY OWI�TER/ N,q�: ,N],a�.�l.;N {�.I�,�I — Z'�E� AUDRESS:,(D�JI' C�>dmeN� ST �c/f CITS� �,�/Dkr1 sTAT�� PxoNE: 7fo3-7R(a - 71R0 ' , CON'rRACTOR ��; E� / �,;,,�, SUBMTT A COPY OF 3TATE LECENSE # a?DI P02.1.2F3 ERP DATE �3/ �Zo��i YOUR. STATE LICINSE �DRES3: 7�8 //3� s4��e CITY/9E/,�/r�/�w/ STATB"�!�Z� S`3 9JITHAPPLICATION pgp� -��3-712.�-p-t FAX '74,3°7��'- 1F135 PROPERTY TYPE � �CT� �AMILY/NEW CON5TRUCTION s� ❑ TWO FAMILY/NE9V CONSTRUCTION STORIE3 FER�� ii�'E - t1 ABDITi9AI GF1sI�D ❑ WH�ff3E3W� - - - 0 BASEIWffiJT FINISH OOF ❑ DRAIN TILE e CI DECK ��ING ❑ OTFIER ❑ 3WIIVIlVIIATO YOOL TYPE OF WORK: 0 NE9V � ADDiTION p MAIIVTfiNANG�IREPAIIi ❑ REMODII.ING DESCRTBE WORK BEINCi DONE:�o-�G �,.c.� /'„D�...o S/ir� SIZE OF INLPROVEMENT LENGTI3 WII7TF! AEI4HT • FL 00 G ❑ i30U3E ONLY . NUMBERflF SQUARES �� EiOLFSE & GARAGE BASF,N�N� REMODEI.iNCi� SUBMIT• � , O ATTACF�D GARAGE 1. Ea�stiag � Plan PROFOSFA SIZE: 0 DETACfIED GARA.GE Z' �6�� p� PR.OPOSID FI�IGEiT: 3. List of �cnctu�a[ membas to be e�ed SIDING ' FOR NE61r COAISTRUCTIOIV INCLi3DIl�iG DECKS, ❑ Virryi �t ADDT!'fONS � PORCHE.4 SUBMIT' ❑ Alumiraim O Trim 1. Site PlaoE3urvey s(mwing thc e�in� snvctares 0 Oth�r O Fasci� ffid !�'QP�d P�.1� �4� , 2. T�c� s�s o€ co�vetion ptar� IN EX[3TTNG OPEIVING3 OYes CtNo IACATTON OF WIrJD6WS 3• ��Y ��uoffi OR FOR NEW OPENINC�3-DESCREBE STLE OF OPFNING CHANGFS & TYPE OF DYIIdD09t� TO BE IIJSTALLED NUMBER OF OYINDOVIi3 ALL FEES �iRE BASED UN VALUATION, INCLUDING THE COST UF LABOR AND NI�iTERiALS: ° (USIlVG THE TOTAL JOB VALIIATION � � Permit Fee Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosian Control Park Fee Sewer Main G4iarg� Tot�al Due -- � - $ , $ O-1 2. $ �• c7� $ $ $ $ $ � d U.B.0 FEE SCHEDUI.E) — �i� �Sq �OCCUPAN'CY TYPE _ See Back Page far Fee Sahedule �.cf Huitdin� P�smit�'ee - — -- -- - - - - -- .�1 timas tke totai job valuatian .0�5 x Permit Valuation 1Vtinimum $.50 $S.QQ (Sta.te Licensed Residentiai Corxlxactors� $I 675 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21 =$ $450 Caa.�ervation Plsn Review Fee Detezmined by Engineering Agreemant neceasar}' f) ATan Necsssary i) Make chesks aa�ble to: Citp of Fridle� A.ti�ch Stipu THI3 IS AN APPLICATI(yN FOR A PERMIT NOT VALll7 UA]TII, FROCESSED I hereby apply for a huilding permit and I acImowledge tbat the mformation ahove is complate aud accurate; that the work �►'iIl be ia canformance with the ordinances and codes of the City of Fridley and �vith the Minnesota Canssruction Cades; tt�at I understand this is not a p�nnit but only an applicatioa far a peamit and v�ork is not to start wsthaut a permi� that the work w11 be in acxordance with the approved plan in the case of all work whi h requirea r' w and agproval of plans. ' SIGNATURE OF AFFLICANT _1/� � PRINT NAR+IE � /I DATE� / _