AF - 45851City of Fridley, Mirm.,
BUILDING PERMIT
Date: _. ����_....�'°"_'.� �..�..�._....._._.__..._..
,'
Owner: .� ..�.._.�'�._.��.� 4._.!�_�,�,;,�' "{.��Builder
Address ....._......._..�._.._...._..•---._.._. _._._.
. ._._...r...___._ Address
N° 4725
�
,� ,;�. , �.00ATI "�V OF BUILDING
No. ��" 1
,C�:'' _._ Street .�_,-;��.� ---_. _ _.. ��..�_.....-----••-------_ Part:� I.ot --_---_....__.._.._...._._�_.._..---------,,—
��' ar�� - � 4 � � .
Lot ._......_ .....,� /.�.........--.--.. Block _..._....--.! -----......_. . . ......... Addition or Sub-Division ,.._.� � ,�•:...
" ,�,,,,,.*.' ,,r+� � ,� � '�� �.��i.�[.- ��� -� .. � •.r-f . . '+�,
Corner Lot .................. .-------- Inside Lot ._._............._................. Setback ...�' .........-----....... 5ideyard ...1��.... �`._....�_....�"...'�.......--------�------..
Sewer IIevation .-------•------.._......._.---------_.._..._..----------••----------------- Foundation IIevation _..__-------......----------------------
DESCRIPTION OF BUILDING
To be Used as: %
„ � �, r�'I' �,� � �' � ,�
_ ;' � � �'� _..� �"_.... Front �""�� G. Depth ,�- ��.--.. Height ��..�, Sq. F� �� �� Cu. F`t. j .---^--- -- �►
���. . — �- --. . ont Depth .. � _ � r He ght /'��r..�.}........ Sq. Ft ���. Cu. FL ..;�,� ��
�,� : ...... . . . ....� - � ,�-�- � - ...._.
' ~�' � ` � °`�.�"� �"',.:::.`
Type of Construclaon .�..:�...:,�.��...... Est. Ca t,��*...,,,�. .-. ........... To be Completed'....-----..._...------......._.
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In consideration of the issuance 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 all provisions of
ordinances of the city of Fridley. �
�.._..._.._...._._..____.____.....�._ ..__._...._._..
In consideration of the a '��
A Yment oP a fee of $:�:,.. ...�...---...._......, permit is herebY granted to---.---_.._---- .............-.._......-----•-----
_.._ to construct the building or addition as described above. This permit is granted upon
the express condition that the peison to whom it is granted and his agents, employees and worlunen, in all work
done in, around and upon said building, or any part thereof, shall conPorm in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. •''--",� �3 , �,
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Bttilding Inspector
NOTICE:
This permit does not eover the eonstruction, installaHon for wiring, plumbtng, gaa heating, sewer or water. Be aure �e see
the Building Inspector for separafe parmifs for fhese ifems.
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Owners N
Address
APPLIClTION FOR BUILDING PERMIT
CIT3t OF FRIDLEY, �OT@
LOCATION OF BiJILDIATG .
No. � C� :�'.5 Stree� • - • � ��a� �✓�'+�--�' Pert of Lot .
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Lot Block _ �,_�„ Addition or Sub.Div,
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Corner Lot�Inside Lot_,_,�_Set Back � F;��„____ 5ide-Yard,,,. /�-� ��
SEWER ELEVATION : . - i �' � � � �-� e �' - - �'OUNDATIQN ELEVATIOAI ,,� Q ° ' �
� , �, , � �"s'�.� � i . •
Applican� attach t,o this form Certificate �f 5urvay of Lot �.rid proposed �building
location. �
DESCRIPTION OF BUILDING
To be used�-ass;
. r '
� n F`ront �, ; .�Depth,*�, � Hei�ht !�
Sq. Ft. Cu. Ft.+,9,_,�,��?�._ • �
�'���� Fi�ont _, f �= Depth� Height �� ��
�_
Sq. Ft. ,�C� � Cu. Ft.
Type of
�
Cost_ %„�� O�'-e� '
To be completed �..�G � , .
3'he undersigmed hereby m�kes application for a permit for the rror� herein specifi�l,
agreeing to do all work in strict accordance wiih the City Ordinances and ruling of
the Depastment of Buildings, and hereby declares that all the facts and repre�ent�-
tions sta.ted 3.n thi:s epplication are true and correct.
DATE � . • ` �1.� � SiGI+I@�'URE ' v
��r.-.�.. �,..._
(A �chedule of Fee coats can tie fowad on the Reverse Side.)
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BOILDING PERMIT FEE SCI�DULE
Section 2, The Inspector of Buildinga shall, before issuing any permit
for the ereotion of any building or structure, or for any addition to
any exist3n� building or atructure, or for any alterations or repair�
to any existing building or structure, upon application therefor� require
the payment by the applica,nt for auch permit of fess to the amount herein
below set forth and in the manner herein provided to-wit:
2.1. For any such permit for the ereetion of any fire-proof building, other,
than a garage, warehouse., factory or grain eleve.tor, or for the erection of
any fi.reproof addition, for simil8r occupancy, to a�r existing building
shall be at the rate of �1.40 for each one thousand cubic f�et, or fraction,
thereof, 3n suoh cubical contents.
2.2. For a,ny such permit for the erection of any iireproof garage� ware-
house, factory or grain elevator,�or for the erection of an� fireproof
addit�lon, for similar occupancy� to any existing building sha�.l be at the
rate of �1.25 for each one thousand cubic feet, classified as "f9xeproof"
by Seation 502 of the Minneapolis Building Code.
HO_, U5ES
2.5. For any such pertnit for the erection of any non-firepa�oof buil.ding
other than a garage, warehouse, factory or grain elevator, ar any non-
fireproof addit3on, for similar occupaucy, to any exist3.ng building.
Permit �Z.00 for each one thousand cubic feet.
GARAGFS
2.4. For any such permit for the erection of any non-fireproof garage,
warehouse, factory or grain elevator� or £or the erection of any non-
fireproof addition, for similar occupancy, to ariy ex3sting build3ng�t'
for each such bu3lding or addition. Ninety Gents for each one thousAnd
cubic feet or f°raction thereof, in the cubical contents thereof with e
mi nimnm of �/a.�00 �
For the purpose of computi.ng fees for building permits the cubical contents
of any building or add3tion to a uniform height throughout by multiplying
the ground area covered from a point six.(6) 3nches below the floor line of
the basement or cellar to the average height of the upper surface or to the
average height of the roof surface of the main gable of a pitched roof.
2.5. For repairs or alterations to an existing structure, the fee shall �e
at the rate of �3.00 for each Five Hundred Dollat'�s (�500„OOj, or f'raction
thereof in ti�e cost of all propoaed work.
2.6. In no case shall the fee chaxged for any permit ae set forth in
Sec'tion 2 be less than �1,,.00,
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LAND SURVEYOR wc�,eoRa
REGISTERED UNDER LAWB OF STATE OF MINNESOTA JYDIC�AL
NC6N86D �r ORDINANCE OP CITr OP NINN6AP�OLt6 .
33Qa LYNDAI.E AVE. SO. MINNEAPOLIS 8, MIIVN. �
TAYLOR 40970
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I hereby cert�.fy that the above is a true and correct plat of a survey of:
Lot 9, Block 1, OSTMAN'S THIRD ADDITION, Ancic� County, Minnesota.
As surveyed hy me this 19th day of January 1957 A.D-
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Signed � � �s � � ��� �, ��„_ �.r_
Minnesota Regt�stration Lvo. 2`384
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sue�ecr PERMIT .
City of Fridley 12209
AT THE TOP OF THE TWINS • p�
; , BU ILDING PERMIT ,
� � ECEIPT NO
COMMUNITY DEVELOPMENT DIV.
� �y_------� ��/
r � � PRO7ECTIVE INSPECTION SEC.
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�� /"'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BV
•"'� � ,'� 812-580-3450
� 910-F15 6/29/73 � /
JOB ADDRESS 7035 Hickory Drive N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 9 �. Ostma.n's Third Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
John L. Lund 7035 Hickory Drive N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGtdER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK �onstruct 34' x 26' Garage and A1ter old garage to living area
9 CHANGE OF USE FROM TO
STIPULATIONS
SEP
ERATE PERMITS REQU�RED FOR �1��N��
HEP►TlNG, PLUMBING AND StGNS.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOC�. F1�IRe
THIS PERMIT BECOMES PIULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R—�. BH�F 8840 Garage
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 WHETHEH SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $6, 004.00 3. OO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER TATE OR LOCAL LAW REGULATING CON-
STRUCTION O HE PERFO ANCE O ONSTR TION. � L9.00
PLAN CHECK FEE TOTAL FEE
• �✓ � ! 3 $32 . o0
_ �NATUREOFCONTRACTORORA THORIZEDAGEN� IDATEI y�l EN PR PER Y LI ED THIS IS YOUR PERMIT .`
. ^ ^� �^� �r`
SIGNATURE OF OWNER IIF OWNER BUILOERI IDATEI BLDG INSP rJ IJAT �
. .. �,. >:r,..r : ��.�.:
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A1�PLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME : a/� t{� �, � ¢r � � BUILDER : _ S � �'
ADDRESS : �4 � S� L�/�%Ly D� • �/. � ADDRESS : �
NO:. �%�S' STREET: /�/G/LolL�/ DQ/Y� /'� ��,
LOT: BLOCK: O ADDITION:_Q$%/!'/��0 5�/l�ik.f�
CORNER LOT ; INS IDE LOT : ''� S ETBACK : S I DEYARD ; `�• 5�
Applicaat attach to this form 7�ao Certificates of Survey of Lot and propoaed
buildi,ng location drawn on these Certificates_. =
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� DESCRIPTION OF BUILDING
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To Be Ueed As; ; •`
« .
� �, '.�� �} � ��� (�..e
�'��� Front: ��� Depth• Z�� Height: '� ��
�� Square Feet: ��� Cubic Feet:
,�i�,� ��- ��4-rQA�r � .
��� �'.Ar�t/Ly ,Q��v! Froat: /`3 Depth: �"�_Height• ��
Square Feet; 3 j� Cubic Feet:
�1/��' — 3oap
�►pe of Construction: �/P�t.- Eetimated Cost;_$ ��r.ii�es R�����
To Se Cotapleted: / I�'%� �, �• � � G' � �`!� , �-
• ? � �,
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Tha underaigned hereby makee application for a permit for the work herein
speei�ied� a�reei� to do all work in sttict accordance with the City of
Fridley prdinaaces and rulings of the Depa�tment of Buildings, �tnd hereby
declares that all the facts aad representat�.ons stated ia this application
are true and correct.
. ,
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nA�: , � —�� � 73 szc�,�•
(See Revezse Side Fat Additioual Informat .) �
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�UILD�NG PERNtIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings sh�ll, before issuing permits fox the
erection of any building or structure, og for any addition to any existing
building or structure, or for any alteration or repairs to any existing
building or stxucture, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set foxth and in
the �stanner herein prwided to-wit:
UNIFORM BUILDING CODE: �ype 1, 2& 4-$2.15 fox each one thousand cubic
feet, or fraction thereof, in such cubical contents. 1j►pe 3& 5-$1.85 for
each rnxe thousaud cubic feet.
ADDITIONAL INFORMATION
�°or t�e purpo�e of computing fees for building pennite, the cubical contents
of anY building or addition, ia determined by unaltiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or tH,e cellar tv the avescage heights of the upper surface or to the average
heigl�t ot the roof surface of the main gable of a pitched roof.
For repaire or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cus� oi al�. propoaed work.
In ao case ah,$11 the fee charged fox any permit as set fvrth in Section 2 be
lees than $5.00,
V�RIFICATION OF FOUNDATION
NO'I'�: Permits for eonstruct�.on will be issued a miaimum of 24 hours from the
time vf application, �o a11uw for proper review af the proposed structct�e aad
of tt�e construc�fon s�g�.
A Certified Survey of the lot, sYno�aia�g the loeation of the foundation, once it
has laeen evnstructed, w�.11 be required be�ore proceedi�a� with the framing.
CERTIFICATE OF OCCIJPANCY
Appliaation for a Cextificate of Occupancy shall be �a.de ten (10) days pzior
to the uae ox occupancy of any stxuctuxe for which a building permit has been
iasued; aad said etructure shall not be used or occugied until � Certificate
of Occupancy haa be�n isaued.
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Yy
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own�r og the proper t�r locat��3
have no objection to the �it;=
allowing the const�uc�ion of a .�,�� to h� located, �,�
�S� - witho�t �iz� requir��i ce�cificat� oi
survey that the City ordinarily requires fuz all new C011StICYEC�lOTi.
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SUBJECT PER
City of Fridley � � � .� �'
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �• COMMUNITY DEVELOPMENT DIV. R EIPT NO.
' ; L �-���-�
r � � PROTECTIVE INSPECTION SEC. �°J ��
� � �
' ' /'��1 � CITY HALL FRIDLE� 55432 NUMBER REV OATE PAGE OF APPROVED BY
�'"""�" �'' 612-571-3450 910-F15 11/18/94 / /
JOB ADDRESS 7035 Hickory Drive NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 9 1 Ostman's Third Addition SHEET
2 PROPERTY OWNER MAIL ADORESS 21P PHONE
Paul Lundequam 7035 Hickory Drive NE 574-1648
3 CON7qAC70H MAIL ADDRESS Z�P PHONE UCENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP pHONE UCENSENO-
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW � ADDITION g ALTERATION ❑ REPAIR p MOVE O REMOVE
8 DESCRIBE WORK
Install sheetrock on exterior/interior wall of basement area and on ceiling; install
egress window
9 CHANGE OF USE FROM TO
STIPULATIONS
Egress window must meet the State Egress Code. Install smoke detectors
adjacent to all sleeping areas and in basement.
5EPARA�E PERM�'�� ��
�tRE� f0�2
WIRING. H�T��IG, .PLU�.�11.i�1� .A� ���
SEPARATE PERMITS ARE REQUIRED FOFi ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD
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 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 8E COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3,900 �1.%S
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEI THE pEHM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �(3.0� Fire ^J�.' �3.90
PLAN CHECK FEE TpTAL FEE
$68.85
SiG� TUREOFCO 'AACTOAORAUTMOA�ZEDAGENT �onrEi WHEN PAOPERL ALIDATED THIS IS VOUR PEHM17
� �/ /l-��Y
GNATU OF OW EAi�F OWNE UILDENi IOATEI BLO INSP f��TE
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CiTY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 1/i/94
��73�
ConstcuctionAddress: 7 ° � 'S �--{ , c,� � '�'
I.E;gal Description: . _
Owner Name � Address: �} r� l L��� v� �� Tel. # S� Y'l c� � 1
Contractor: c.s� �A �'
Address:
LIVING AREA:
GARAGE AREA:
DECg AREA:
�,(01'I�R:
MN LICENSE �`
Attach to this applicatian, a Ceit7ificate of Survey vf the
lot, with the proposed construction drawa on it to scale.
Length
Length
Length
�9 G` e
DESCRIPTi0A1 OF IlViPROVEMENT
Corner Lot [] Inside Lot [] Ft. Yd S�back
Type of Constxuction:
Approx. Completion Date:
Driveway Curb G�.it Width Needed:
DATE: �� 7$ g y APPLICA
Permit Fe� .
Fire Surcharge
State Surcharge
SAC Charge
License Sarcharge
Driveway Escrow
Erosion Control
Park Fee
Se�ver Main Charge
TOTAL
STIPULATIONS: '
Width Height
Width Height
R�idth HgtlGround
Tel. #
Sq. Ft.
Sq. F�
Sq, Ft.
�-+7 � �'�h �s�. �PS�wwee�T PTce�a
��C �G t' /�El�?� �i1� %�C/��d.� //� o�G�! lJ/� � � �rC! �.1�� �
Side Yazd Setbacks
F.stimBt+ed Cost: $ 3�0 �� � c�
{Cost on Back)
+ 6 Ft = Ft x $
�[_M._ `!__ � !_ _
,;
_$
Tel. � � 7 �i�-i�Y �
$ (��. 0 6 Fce Schedule on Reve� Side �
$ �. �C) ..001 of Permit Valuation (1llOth%) .
s /. 9s' s.soi�i,000 v��on -
$ $� per SAC Unit
$ $5.00 (State Licensed Residential Contiactors)
$ Alt. "Ap or Alt. "B° Above
$ $450.00 Conservadon Plan Review
$ Fee L�etermined by Engineering
$ Agreement Necessary I l Not Nec�essary [ l
$ � �°�'
�
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,
I3UiLD[NG PERMIT FEE SCHEDULE
1'hc Chief Bui(ding Oft�icial shatl, t�efore issuing �-cnits for the erection of any building or structure,
or for any addetion to any cxisting building or structure, or for any alteration or. repair to any existing.
• building or structure, u�ion apptication therefore, requice the payment by the ap�licant for such permit
c�f fce.s t<� thc amount herein below sct fortl� and in the manner herein provided to-wit_
. , • _ � � ., �.,,r , -- ,
. "I'OTAL VALUL FE� �
$i to $S00 $IS (Miniuium Fee is $15 pius surcharge)
$501 to $Z,Q00
$Z,001 to $25,000
$25;001 to $50,000
� $50,001 to $100,000
$100,001 to $500,000
$500,001 bo $1,000,000� -
$1,000,0p1 and up
�
$15 for first $SOp p[us $Z for each additionai $100 or
fraction thereof, to and 'utcluding $2,000 �
.$45 for fust $2,ppp plus $g for each additioual $1;000
or tractian tt►ercof, to and incluiiing $25,000 •
$252 �for fust $25,ppp pl�s $6_50 for each additional $1;000
or fraction thc�eof, to. and including $50,000
$41450 for first $SO,ppp plus $q._Sp for each additional
.$1,000 or fiac6ton t�aeof, to -and including $100,0()0
$63950 for first -$1�,(lpp plus. $3_50 for eact� additional-
�1,0� or fracliou thereo� to aad including -$50p,00Q
$2�39.50 for dze fust $�p,ppp pi� $3 for each $dditconal
$1,000 or fradion th�eof, to and including $1,000,000
$3539_SQ for the fust $I,pQp,ppp plus $Z for each addilionai
$1,OOQ or fraction �thereof -
DRIVEWAY DEPRESSIpN ESCROW
(Coacx-ete Ctufi Sireets Only)
Aiternate "A°: Removal and repl,acement af curb and g��. o�y _���y width plus 6 feet times
$13.50_
Alternate "B": Removal and repiacemeni of curb and gutter and instal1 a 3 foot wide
approach with 6 inch deptfi - Driveway width pius 6 feet times �15_75.
VERIF[CAT[ON OF FOUNDAT[ON
PermiLs for construction will be issued a minimum of 24 hours from the time of a�plication to a[low
for proper review of ttie proposeci stracture and of the construction site_
A Cectifcate of Survey of the lot, showing the location of the founciation once it hae it has heen
constructecl witl be rc;yuirect before proc�eding with the framing_
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Building
Inspections
763-572-36(?�F
76�-502-497� FA�
STfE ADURESS � }C�?� I
7}�I�S APP�.CCAN7' IS:
i'ROPERTY OWNER/
TPNANT
CONTRAGTOR
SUBMtT A COPY OF
YOUR STATE L[CEINSE
AND C�t.t`f�CA'r'� O�'
YNSURANC�
PROPFRTY TYPE
PE�T TY�YY�
From: 7635376376 � �,Pa�e:,2/3„ Date: 6/1/200911:58:00 AM
BiTILDING
RESYDEN'T� A�p�.I�A'I'�ON
CITY t'�F FRIDLEY
EFFEC7iVE I-1-09
Y'OCn2 B-MAT)� AD�RESS
�iCONT1tACTOR
�SMGLB PAIVIIY.'Y/A1�iW CONS'Y"Rl7C'rlON
� 7�VV0 FANdLYlNEW CON9TRUGTfON
O BASEMENT FINlSt! OOF
o nBCS s�awo
�rrE oF wQRx: Q iV�W HQME CONS7ZtUCT10N o,►nnmo�r
' �MABV'fFdtTANCFJREPAIIt � REM4DELING
D�'sSC��s'GVO� H�iti �ON�s: �
SiZE OF Il4It'ROVEMENT LBNGTH 'W�'C�T
� O HOU3EONLY
NUMSER OF SQUARES �_ G7 HOIJ3E & OARACrE
aR� srzE: �nE�°rncH� Ga�Rnn � pr�l�
P'ROY03ED HEII�HT:
� narE
o nrs��n� ��e
fl o�
,.�, ,,. � � „ ..
Pernnit N'o.:
Recei�ved B�:,
baxe �
BAS�i7'1�C. nDEr INd cllgMiT�
l. ExiB�ing i+Iqpr pl�n
z. P,�oposeafEoorplaa
3. List of structutel membe�s to 6e �sed
� . FOR N6W CONSTRiTG°liO1�T INCLUDIlVG DECKS.
AriAITTON3. � pC11t�F�^ S rBMC1P•
O�mum p�� I, Sfte Pleo/Survey shawiog the edsdng �etiues
❑ otl�er ❑ Fa�nia �1 Pr�o�d Dmiect
2. ltvo sets of oo�toa plans
�$iS 3. �nergy CC�Iculations
UV FX4^iTINfl OPFdVI1+f03 OY� ONo LOCAITON OF VdI1WOW5
OR FOR N�VV OPEN Wt�S-DESCR�E 817.E OF
4P�1'i3 Ci�ANa�3 &
'Y'YPB QF WI1VD(�Vy TO BB [NSTALLED 1�TCiM�EYi OF'6U�0'GVS
Ai •i • FEES ARE SASED ON VALUATION, iNCLUDING THE COST O� LA�OR A1�1b 1l�A7'��A�fi:
S,ING 7'AE 1997 LT.B.0 I'EE SCHEDULE)
�TAi..�O� VAi.YiATYdl�i $ �� O ()[''.CIlPANCV TVtyF.
Plaa Yteview
Biro Surcharge
S�harge
iicense 9uraha�ge
5AC Charge
Curb (�t �scrow
Br�ian Control
P�rk Fee
Sewer M�in Cherge
Total Due
See Back page for �ee Schedule
b5% of Buildiitg Permit Fee
.001 times the total job valuat�on
.OQOS x permit V�laation Minimum $.SO
$�AO {State iicensed �t�ide�tial Contractors)
$20U� per SAC CJnit (i'lans to MWCC for detennmatioa)
ft-rbft= ftx$21=$
$450 Conservatian Plan Roview
Fee Y7etexmiaed by �ngineering
Agreement neeassery ( ) Non Necessery ( )
'IT�IS IS AN APPLICATIQN FO�. A P�T-NOT �'AY+T�1 UN"�"tY. PRQC6S5�
I her+eby apply far a build'mg germit and Y acknowledge d�at the information aho�re is complete and accure�e; that the wark w;l! be in
rAnfotmence r+vith the ardinsnCes end codes of tht CiCy ef Fridley and witl� the 1V�innacota Consh�uction Cades; rhat I undersrtand this is not a
ptrmit b�d only an applic�tion for a�rmii and work is not to start vyithout a permit on site; that the work will bo in aceurdance witb the
aFPi'm'ed Plan in the cae o or1 ch ires review and approval of plans. �
S1GNA7URG OC APPLIC PRINT NANt� ��^� 1J1:_JC�� DA'fC��� I� ,�