AF - 46228�City of Fridley, Minn. �
BUILDING PERMIT N� 41ss
Date: .....�.__�....---�_..../.l ......�� _......._._....
Owner: .. . .__......_ __ ._._..__.. ._ ..._...... _ ...
---.......__ Builder ..0 �,rl...�/�'�� �-�T+Gl71__°�.'....,c6�����En-.t,`
Address
Addrnss
/� CATIO OF 8 ILDING
No. /�yi Cl Street /�6���+�,a__....�.�... .�... r _ _ ...._ Part of Lot ._ _ .
-.__��l� __ �
Lot ._� � __ Bloek ._p� ...... Addition or Sub Drvision . _- _. .. /Sl�.Q_-��
a ,�^�
Corner I.ot .__ _ Inside Lot �i_ .___... Setback .s�� �_._..._ SideYard � O d r�Y-..11 � y
Sewer E3evation
To be Used as:
.. ..A��iG.l��..^..�1 _.........
-��R .
Type of Construction
Foundation Elevation
DESCRIPTION OF BUILDING
Front I�-a-.._� DePth �P O,HeiSht /7 '� Sq.
� , / _� .
Front f�Q' D Depth c�� �% Height ! Q-� Sq.
�t. �t �G�9�.� `s° To
In consideration of the issuance to me of a pernut to construM the
the proposed wo¢�k in accordance with the description above set foqi� a
ordinances of the rity of Frldley. ��
In consideration of the payment of a fee of $
Ft. �,�j�aZ G�1.
Ft 'y4Z . a Cu.
be Completed ... ___.._.
Ft °7.� /+�I
%..
Ft �.Q_�
described above, I a��ee to do
nplignce with �,Il provisions of
is hereby granted
...__.._........_..._..._._.........__.........---...._._.__.. to construct the building or addition as descri6ed above. This Permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said buIIding, or any part thereot, shall conform in all respects to the ordinances of
Fridley, Minnesota regai+ding location, construction, alteratioa, maintenance, repair and moving of buildings
within the city lim3ts and this pernut m�y be revoked at any time upon violatlon of any of the provisions of said
ordinanrRa � .. i _ . n
Buildin8 I»ap¢ctor
NOTICE:
Thi� permi� does no� eovar the wnelrucfien, insfallallon for wiring, plumbiag, qas he�ting, sewer oe wqa. Be� wn fe s��
h I the Buildiny Inap�cler for sepneN parmiN for 1Lase ifems.
����� ' ��
,\
�04
sua�ec* . � � PER .
City of Fridley a� � 5 5 5 a
ATTHETOPOFTHETWINS BUILDING PERMIT �
' ^ RE
� �
� � _�� _ C�MMUNITY DEVELOPMENT DIV. �
r � L PROTECTIVE INSPECTION SEQ � 7 q��
�
1 �
, � �°9 • CITY NALL FRIDLE� 55432 NUM9ER REV. ORTE PAGE OF HPPROVEO B�
i""� � ,�� 612-571-3450 g70-F15 �
11 15/79 � �
108 AODRE55 1000 Hacl�ann Circle N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR.. 2( 2 Parkview Heights SHEET
2 PROPERTYDWNER MAILADDRE55 ZIP PHONE
Earl Hanson 1000 Hacl�ann Circle N.E. 574-9629
3 CONTRACTOR MAIIA�ORESS ZIP PMONE IICENSENO.
Coordinate Pxnducts Co. 8535 Central Avenue N.E. 786-0830
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGWEER MAILADDRESS ZIP PHONE LICENSENO.
6 USEOFBUILDING �
Residential
7 CLASSOFWORK
❑ NEW X ADDITION ❑ ALTERATION p REPAIR ❑ MOVE ❑ REMOVE
8 OESCRBE WORK
Construct a 20'3" x 28'�" tuck under garage under existing garage to be
cornrerted to living area
9 CHANGEOFUSEFROM TO
STIPULATIONS �
Part of the existi.ng garage must remain storage area (east portion).
� ��
rn m o
SEPERATE PERM! r S � � �� m� �
Rc��(,iR�D Fpp, Y1�lr?liY� ";' "'�' �
HEATING, PLU�,78l;VU AN� � �j �v� �q
5l��LS. � ° �
_, — „�,
s �
Li+ � y ^
' Y�
i �_
-T. �� =
x m �:
� � �
N
TYPEOFCONST. OCCUPANCYGPOUP OCCUPANCVIOAD
SEPARATE PERMITS ARE REQUIPED FOR ELECTHICAL,-PLUMBING, HEATING.
VENTIIATING OR AIR CONDITIONING. .� IQOOC� FY'itRO
TMIS PEPMIT BECOMES NULL AND VOID IF � WORK� OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTMORIZED IS NOT COMMENCED WITHIN BO DAYS,� OR IF CONSTRUCTION
OR WORN IS SUSPENOED OR ABANDONEO POR A PERIOD OF 120 DAVS AT S%�J S7iO
ANV TIME AFTER WORK IS COMMENCED. . NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFV THAT I MAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
ANDKNOW7MESAMETOBETRUEANDCORRECT.ALLPfiOVI510NSOFLAWS VALUATION SURTAX
AND ORDINnNCES GOVERNING THIS TVPE OF WORK WILL BE COMPIIED
WITH WNETHER SPECIfIEO HEREIN OR NOT. THE CaRANTING Of A PERMIT $3, 254 $1.63
DOES NOT PRESUME O GIVE AUTMORITY TO V�OLATE OH CANCEL THE pERMITFEE SACCHARGE
FOVISIONS OF A HEk STATE LOCAL LAW REGULATING CON-
CT R P q ORMANCE CONSTRUCTION. y�21.O0 NONE
PLANCHECKFEE TOTALFEE
��
$ 5.25 $2%.88
W UREO O �CtOnO uiHOAiZEDnGENi ��i � WHEN PROPERLY V ATEO THIS IS YOUR PE MIT
�
SiGNAfUREO WvERtlFOWNERBWLDERi i�<iE� BLOG �NSV �iE
CITY OF FRIDL[Y
APPLICATION FOR RESIDf:NTIAL 6UILL`IPJG PERMITS
(�Jew, Alterations, Additions, or Repairs)
OWNER: �i/ ��t�
ADDRESS: %G�% �� /inj�r/ ��
7EL N0: �� — %���%
� ����1
/y/G�C6�'
BUI LDER : �OYAiiiGtTP dj'�dS � �� ^
ADDRESS: .F� �� CG?-ryYG�`.h��-E' %��
TELNO: %F,EJ���O
Construction Location
STi2E�T N0: � STRELT: �z C i4 }-<%G'f�/ � YC G���
LOT: e�(� BLOCK: �. ADDITION: ��l��iICS�-�' `L-�1���oN/�
Corner Lot: Insine Lot: Setback: Sideyards:
I�pplicant attach to this form two Certificates of Survey of lot and
prop�sed building location drawn on certificates to scale.
DESCRIPTIOIJ OF CONSTRUC??ON
�uC�-uNd&2.
/� � �
I�CfJ(C��l � Front: aC� ��� Depth: 02 a`��i. �� Heiqht:
Sauane.I'eete ��%7 Qibic Feet:
Front:
Square Peet:
Depth:
(.Ubic Feet:
,�Q y�1 �c�l-� -�y%rl,e
Type of Construction: �,,�i�( rAh��r (ar ;o�
Zb Be Cbmplete��.• i �! , � / �
Proposed Driveway Width If New Opening Is Desised: _
Height:
/� `
Estimated Costv $ �
.3i Z.�°�' 2�
� Alt. A Alf. 8
$ $
SEE REVERSE SIDE OF SHEET _
7he undersigned hereby makes application for a permit fcr the �.ork herein specifieci,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings of the Depariment of T3uildings, ann hereby declares that all the facts and
represen:ations stated in this application are true and correct,
DATE: II Il� I�� SIGNATURE:
_�_'%
Stipulations:
s��l �s� � 3zsy.i� -t
���;r �, 3E, 3. �� 6 - z/.od
Pe st�
/
4 � �
1
27.� �
P�.r oF
3, 2SL T►+� Eti�,rwt
� �n.�}c � rr►�bt
i��►�v� e,� S�a���-, �
�a�,�. CE� P..��,
�-------
� SUBJECT P .
r�City of Fridley 19867
�ATTMETOPOFTWETWINS gUILDING PERMIT !
, � IPT
.� �v�� _ COMMUNITY DE�ELOPMENT DIV.
r y� .�� � pppTECT1YE INSPECTION SEC. 3a�-�S
. _i . ! . . i . � �: . .
� � /'°l • CITY HALL FRIDLE� 55132 �+UUBEP FEV. O�TE vpGE Oi nGVROVED Bv
`�'""'�"� ,'� 612-571-3450 9t0-Ft5 5/2/89 � �
lOBA0DRE55 1000 Hackmann Circle N,E.
1 LEGAL �OTNO. BLOCK TRACTORADDITION SEEATTACMED
DE$CR. 2( z. Parkview Heights Addition SHEEt
2 PFlOPfiRTYOWNER MAILADORESS ZIP PNONE
Earl Hansen 1000 Hackmann Circle N.E. 574-9629
9 CONTRACTOR MAIIADORESS - ZIP � PMONE LICENSENO.
Stockdill Constructi,on 2925 Noble Avenue North, Golden Valley 55422 521-7571
/ ARCHITECTORDESIGNER MAILADORESS � ZIG PHONE LICENSENO.
5 ENGINEER MAILAODRE55 ZIP PMONE LICENSENO.
e USE OF BUIL�ING � .
Resid�ti.al
7 CLASSOFWOPK
❑ NEW ❑ ADDITION - ❑ �ALTERATION �l REPAIR ❑ MOVE ❑ REMOVE
B �ESCRIBE WORK
Reroof Dwelling (30 Squares)
B CHANGEOFUSEFROM TO
STIPULA710NS
On a0 new roofs or teereffs and replacement rooh,
Stete Code requtres tAAt 2 layers of 15 Ib. falt,
maDped togethe►, b! instaq�d 1q a point 2d ind�es
up from extenor wap 1iac, o� �a �ss ci o�r
appfoved undeil8yment IqeArbrap�
SEPAPATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING. HEATING, �PE OF CONST. OCCUPANCV GflOUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTFUCTION ZONING S�.FT. CU.FT.
AUiHORIZED IS NOT COMMENCED WITHIN 60 DAVS, OH IP CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 DAV$ AT
ANV TIME AFTER WORK IS COMMENCED. � NO. DWLG. UNIiS OFFSTREET PaPNING
1 HEREBV CEFTIFV THAT I HAVE READ AN� EXAMINED THIS APPLICATION 1 STAIL$ GARAGES
ANOKNOWTMESAMET08ETRUEANDCORRECT.ALLPROVISIONSOFLAWS ypLUATION SURTA%
AND ORDINANCES�GOVERNING THIS TVPE OF WpRK WILL BE COMPLIED $l�SOO S.%S
WITH WHETHER SPECIFIED MEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL TME pERMITFEE SACCHARGE
PROVISIONS OF ANY.OTMER STATE OR LOCAL LAW REGULATWG CON- �S'3S•OO
STRUGTION OP THE PERFORMANCE OF CONSTRUCTION.
PLANCHECKFEE TOTALfEE
$35J5
SiGr+amnEOrGOr+rnnGiOROenUtHORUEO�GErv1 marEi yyHEN PROPERI VALIDATED iH15 IS VOUR PERMIT
cS a
SiGNPTpPEOFOWNERiIFOWNERBUILOEFI IOATEI �BLOG!N5� �ia �
� [ )
� L l
�'� [ l
Co�tructi� naaress:
3 s �s
I�1 AND R-2
Building Permit Application
Effective 5/1/88
� �
�
�
IPgal Description:
a,,rer rrame &�..�-�-----: Er�r� %�n�san JG� N�f.,n�.A G,�(� A,f�+el. # S7 - 629
OontraCtor• _7 Tn�. � N � �f ON ,�, � 7+e1. � SZ � `7 � ��
�: 2�Yz5- lvobl,� ,��P lV
LI�►II�IG AREA:
C,ARFrGE ARF.A:
�.o-«� ..,�.
O'li�[t7
Attach to tl�is applicatio�n, a Certificate of SUivey of the
lot, with the proposed oaistzuctioci drawn on it to scale.
�
.�
Width Heic�t
Width Heic�lt
Width Hgt/Gmtmd _
Sq. Ft.
Sq. Ft.
Cbrner Iot [] Inside Iot [] Ft. Yd Setback Side Yard Setbacks
Zype of oonstructi�: Fstimated oost; S �SOC�
Approx. Crn¢>letioai Uate•
.�.._-. � . - •.- �� _.
/ � .
u � � �. / � � - � •
, /� �I�!i.L_ ./// �
/ �/
�2lillt �''EE ,}� .5•04
state suxrharge $. . 25-'
SAC Chazge $
Drive�ray Escrow $
Park Fee $
Sewer Main Chatr�e S
. �•
stzF[np,TTaNS:
$ �-S•%�✓
w4q i�:�- � i
Flee Sc3�edule rn Faever^.�e Side
S.so/Sl,000 valuatian
$575 per SA�C Unit
Alt. ' nprn a2' Alt. "B" Above
Fee Det�esmined by F]1gii�eetix�
��Il ���[]
On all new roofs or tear�offs and rep►aceme�►t ��
gtate fqde tepuires that 2 Iayas oi 1S ID. 'fett,
moppad .1aBet�, � �� � a ��t 24 inches
uD � e�te�ia wall line, nr the �se ��
�ppro+�d unoert�n+� memb�a�
� .-a _ .
� -
� � � �� s�s�etr . . . � . P .
� c�ty of Fridl�y 9 8 0 7
A7THE�OPQFTNETWINS gU1lDING PERMIT
� . o.
, .,
� �y �_���_ COMMUNITY DE�EIOPMENT DIY.
� � � PROTECLIVE INSPECTION SEQ �1��
�
� � �'�'1 . CI7Y NALL FRIDLE� SSIj2 NYMlEN XEV O�TE V�GE O� �P�ROVEO !v
t""� � ,'' 612-571-3450 910-F75 7/1/99 � �
,oe .00ness 1000 Hackmann Ci rcl e NE
1 LEGAL ��TNO. BLOCK ��� �RACTOpAD01TION SEEATTACHED
DESCN. Q( 2� Parkview Hei hts AC1fI0. SMEET
2 PROPERTYOWNER � M�ILADDFES$ � 2�P PMpNE
Nansen 574-9629
3 CONiHACTOR MAILADORESS 21i VXONE LICENSENO
Pennington Const. 4347 Central Ave NE C 1 -
� ARCHITECTORDESIGNEH MAIIAD�HE55 � ZIi PMONE UCENSENO.
S ENGINEER MAILAODRESS . 21V PMONE LICENSENO
8 USE OF BUILDING
Residential
� c�ass oF wopK
❑ NEW O ADDITION O ALTERATION jp� REPA�R ❑ MOVE O REMOVE
e DESCRI9E WORK
Reroof house and ara e 32 S Tear-off
9 CHANGE OF USE FNOM TO
STIPULATIONS �
Underlayment must comply with the State Building Code.
TYPEOF(7pN5T. OCCUPANCYGPOUP OCCUPANCYLOAD
SEPARATE GERMITS ARE REOUIRED FOR ELECTNICAL, P�UMBING. HEATING.
VENTILATING OH AIR CONOITIONING.
THIS PERMIT BECOME$ NULL ANO �OIO IF WORK OR CONSTIIUCTION IONING 50. FT CU FT.
AUTHOHIZEO IS NOT COMMENCED WITNIN 60 �AYS. OR IF CONSiRUCTION
OR WORK IS SUSPEN�EO OR ABANDONED FOH A PERIOD OF 1Z0 DAYS AT
ANV TIME AFTER WORI( IS COMMENCED. NO. OWLG. UNI75 OFFSTREET PIRNING
I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED TMIS APPLICA710N ST�LL$ G�RAGES
ANDI(NOWTMESAMETOBETRUEANOCOfiRECT.R��PqpVI510N50F�pW$ yp�UATION . SUA7A%
RND OROINANCES GOVERNING TMIS TYPE OF WOPK WILL BE COMGLIED
WITM WMETNER SPEdFIED MEAEIN OA NOT. TME GNANTING OF � PERMIT $2797 � 1.40
DOES NOT PRESUME TO GIVE �UiMOpITY TO VIOI�TE OR C�NLEI TMk pERM17FEE SACCHAPGE
PROVISIONS OF ANY OTMER STATE OR LOG�� LAW REGUL�TING COH�
TRUCTIpN Ofi E VEpfORMANCE OF C STAUCTION $83.25 � � Fi re �C. 2.80
� /'Q �� � . PUNCHECNfEE T0T�4FEE
U Licen 5 2 45
S�Ga�*uAEO�CON'Aa�rpaOA�u��0A4ED�GE�+r —�O��Ei 1/EN ROP ALID � IS =�EA�
i
$�GNbUAfO�OWNEA���OWMEaBWlOERi IO�iE� � B G�w$o' ��If
NEW �"
ADDN
tu,TEx
`Ll
Il
Il
co�c�ouona►aa�s:
I,egal Descripdon:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
C�Ci�/lS e �l� �o� HGiGfc(�'IQvI�! C
Effective 1/1/99
'\
�`��a��
OwnerName&Address: �p v� S�'�1 ��iin t1QcK►hqhN Cj ✓ Tel. �f J�7y—�%6ai�%
Contractor. �e v1 v� i in A'�o w B NS f MN LICENSE �1 o�O ( c9 `7.3 g�
Address: �{3�I7 C_.P vi'f'rG1 � �V e . /v�� Tel. # �� �r�� �i
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application> a Certificate of Survey of the
lot, with the proposed construcdon drawn on it to scale.
I.ength
L.ength
Length
DESCRIPTION OF IlIZPROVEMENT
Widfh
Width
Width
Height Sq. Ft.
Height Sq. Ft.
Hgt/Ground _ Sq. Ft.
Consuuction Type:�� t/0 0� Fstimated Cost: $��� �� 3� 9%
(Fee Schedule on Back)
Driveway C3ub C�t Width Needed: _Ft. + 6 Ft =_Ft x$ _$,
DATE: ��3�- 4 9 APPLICANT: �i o k h �J� V s� 0/' � e Tel. 1l q� 9-6 ro 9
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Fscrow
Erosion Control
$ 3.0?.�
$ a•�o
� ��b
$
$,�2- ��
$
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Pazk Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
TOTAL
$ � S
STIPULATIONS: �
Building MECHANICAL -
Inspections RESIDENTIAL APPLICATION
763-572-3604 CITY OF FRIDLEY
DA7'B g Z, �� YOUR &MA1L ADDRESS
SITE ADDRESS _
TF�DS APPLiCAM IS:
OWNiER�
TENANT
SUBMIT A COPY OF
YOUR STATE
LICENSE WI'fH
APPLICATION
PERNIIT TYPE
TYPE OF WORK:
❑ OWNER �NTRACTOR
�
PHONE:
STATE llCENSE 9_
ADDRESS:�.�
PHONE
'fl Si1dGLE FA1.�IILY
,— J "`
n � ~
❑ "RVO FAMILY
o x��.nnc�T
DETAILED DESCRIPTION OF WORK
O TOWNHOUSE
o n�iunowx�+onn.
�
Permit No.:,
Received
� . �,��:;.
PER MS 168.665 the permit fee is a minimum of SI5.00 or 5% of the total cost up to 5500.00, whichever is greater, fo� the
improvernent, instalLation or replacement of a residential fixture, excluding tbe fn:tures. (This should refled only tbe cost of labor )
Labor wst under $300 = 515.00. Labor cost betw'een S300 to SS00 = cost of labor x.OS =
FOR PROJECTS WI�RE 1.4BOR FJCCEEDS 5500� i'EES ARE SASID ON 510.00 PF1L FIXTURE, IXCEP'r � V��: n(AIDICAl'E 7'OTAL
NUA�BFJt OF EACH BII.O� v LI.� /�. �CS � i SIZFJBTU � G7
EquiPmentlnslalkd , tvffCs: 3 MODEL: _�_ SIZFJBTU
�,,¢�. MODEL:
MFG: MODEL: SI'LFIBTU
A/C 525.00 �REPLACE (GAS) f15.00 GAS RANGF/OVEN S1D.00
AIR TO A1R EXCHANGEFR f 15. FIREPLACE IWOOD) f35.00 _NEW GAS GRlIL 510.00
BOILER 535.00 � _FURNACE 535.00 GAS UNIT H'I'R SI0.00
�—C[�,.IIdEY I,iNER S10.D0 GAS DRYFR 510.00 �POOL HFATER II5.00
—... tlllDYfllIM �TGASPIPiNGS10.00 �VFNfD-A7bRS15.00
Surchazge
'fOTAL DUE
:.—.._:. ._..... . . _
s Number of fixcures . x ._
S ,-50 Number of fixhues (a� SI5.00 � x 515.00 = S
S Number of fixtures Q 525.00 x$25.00 =$
Number of fixtures � S35.00 _ x$35.00 = S
State Surcharge = .50
Tota1=
7}Qg �,e,7J pppLICATION FOR A PERMTf NOT VALID UNTIL PROCESSID
I hereby apply for a building permit and I aclmowledge 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 Conslruction Codes; ihat I understand this is
not a permit but only an application for a permit and work is not to start without a pecmit; that iha5work will be in accordance with the
approved plan in the case of a work which req ' s iew and approval of plans� / � �-
PRiNTNAA� � e r� N` DATE c9�� ��
SIGNATUR£ OF APPLICANT '
City of Fridley
Building Inspections Department .
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building
Inspections
763-572-3604
763-502-4977 FAX
fIATC / ' . /� -V
SITEADDRESS' /J/J�/
THIS APPUCANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING 0
SIZE OF [MPROVEMENT
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1•1-08
YOl3R E-MA[L
OCONTAACTOR
PHONE
STATE UCENSE N
❑ SMGLE PAMILYMEW CONSTRUCTION
❑ TWO FAMILYMEW CONSTRUCTION
❑ BASEMENT FRJISH �:ROOF
❑ DECK ❑ SIDING
❑ NEW HOME CONSTRUCTION
❑ MAINTENANCE/REPAIR
ROOFING ?`
NUMBER OF SQUARES ✓�!
GARAGES
PROPOSED�SIZE:
PROPOSED HEIGHT:
SmING
❑ Vinyl
p Aluminum
❑ Otha
r�.G CITY F,L�+O�
��
CITY_
FAX
EXP DATE
SIZE
STORfES
lSHED ❑ WINDOWS
O DRAM TILE
- O OTHER
NG POOL
❑ ADD17'ION
❑ REMODELMG
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
OSoffit
p Trim
❑ Fascia
WINDOWS
M EXISTRJG OPBNiNGS �Yes ONa LACATION OP WINDOWS
OR FOR NEW OPENiNGS-DESCRIBE SIZE OF
OPENING CHANGES &
'TYPE OF WIT3DOW TO BE INSTALLED NUMBER OF �
ALL FEES ARE BASED ON
'OTAL JOB VALUATION
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License Swcharge
SAC Charge
Gtiub Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due
THE 1997 UBC FEE SCHEDULE)
Permit No.
Received
Da�'
Ssy3�
A"fE_ZIP
�i
BASEMENT REMODELING SUBMIT:
I. Existing Floor Plan
2. Proposed floor plan
3. List of strucWral members [o be used
FOR NEW CONSTRUCTION MCLUDING DECKS,
ADDITIONS & PORCHES SUBMIT'
1. Si[e Plan/Survey showing �he ezis[ing swcWres
and proposed project.
2. Two seu of consWCtion plans
3. Energy Calculations
MATERIALS:
TYPE
See Back Page for Fee Schedule
65% of Building Permi[ Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1825 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checics pavable to: Citv of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and 1 acknowledge Ma[ the information above is comple[e and accurffie; that the work will be in wnfortnance wilh [he ordinances and codes
of the City of Fridley and with the Minneso[a Construc[ion Codes; Nat I understand this is not a pertnit but only an application for a pertnit and work is no[ [o slart without a
pe1mi[ on site; that tl�e work will be in accord e wi�h the pproved plan in Ihe case of all work which requires review and app,ro/val of plans.
SIGNATURE OF APPLICANT /Js PRINT NAME�%i%�L 6�'%��.,�Ll% DATE�
APPROVED BY ' DATE