AF - 46553� CA/NE � ASSOC/ATES
LAND SURVEYORS, /NC.
/7720 Highway 65 N. E. Sodervi//e, Minnesofo 55304
434-7646
AS-BUILT SURVEY FOR: Tkaczik Construction
LEGAL DESCRIPTION: The west 70.00 feet of the east 90.00 feet
of Lots 80, 81, 82, and 83, Block A, RIVER
VIEW HEIGHTS, Anoka County, Minnesota.
Subject to an easemen� for street and utility purposes over the south
12.00 f eet thereof.
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O DENOTES //1' /NCJV /RON P/Pd SLrT.
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BEAR/N�iS SMOM'N ARE ASSI/AIED.
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! /1£REBY CERT/FY TNAT TN/S SI/AVfY, �LAN,
OR REPORT WAS PI96PARE0 BY A/E O/4 GVDER
A/Y O/R£CT SUPERV/S/F!N AND TNAT / AM A
DULY R£O/STERED LANO SURV£YOR UNBER
TNE LAW& Of TNE Sft4TE 0F M/IVIY£S�TA.
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OATE A� � if REG. NO. �885/
JOB NQ �'7-Q1 SEC. 3' 7. JO R. �.�
sue�ecT P MIT NO.
CitY of Fridle '
AT THE TOP OF THE TWINSy g U I L D I N G P E R M I T °- _ 18 8 3 0
r
� � RECEIPT NO.
COMMUNITY DEVELOPMENT OIV. � ��� �
r� � L • � PROTECTIVE INSPECTION SEC.
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•--_� �/'��,`j CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVEO BY
t 612-571-3,450 910-F15 3/20/87 / /
JOB ADDRESS 451 Hugo 5treet N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. W%0 � of the E. 90 � � 8� � 8�. � 82 � 83 � B�,OC�S A� Riverview Heights SHEET
2 PROPEHTY OWNER MAIL ADDRESS ZIP PHONE
Richard Tkaczik
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Tkaczik Construction Inc. 12323 Gladiola Street N.W., Coon Rapicls, 55433
4 ARCHITECTORDESIGNER MAILAODRESS ZIP PHONE IICENSENO.
421-9009
5 ENGINEER MAiLADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDINC3 •
Residential
7 CLASS OF WORK
� NEW O ADDITION ❑ ALTERATION O REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Construct a 36' x 22` Dwelling and a 19' x 22' Gara e
ACCURACY OF UTILITY LOCATIONS �ND ELEVATI�fV,�,
9 CHANdE OF USE FROM • �°
AR�D PERSO�t� kJSIfVG THIS INFORMATION SHOULJ
STIPULATIONS provide a hard surface driveway. Provide sod in t'he front and side
yards. Provide City with copyof verifying survey before capping.
SEWER LOCATION: WYE ONLY (21' Deep-� May have a 6' riser) 137' [�. of NIII
WATER LOCATION: Approx. 10-12' E. of Sewer Service: 36.5' W. of power pole.
DRIVEWAY ESCROW: 16' + 6' = 22' X$13.50 =$297.00
�����a���±�
�EPARATE PER�VI9TS �LQUIR�� F�y� ��f+ore di�gin� cell �or9a� ut;s;;;:z
IIVaRIIVG, HEATIIV�, �LUM�361�G q�� �dr����a TEt�P�1�N� � ELECTRIC � G,?� �_;:�
REC��JlR�� ���' t_.�:t�„�:
SEPAHATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATINQ, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. 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 REAO 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 WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S58�SOO $29.40
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PFiOVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $31.0.00 $525. OO
PLAN CHECK FEE TOTAL FEE
$ 77.50 $941.90 + PE & DW
SIG RE OF CON i RACTOR OR AUTh10R12ED AGENT �DATEI �,-�
�` �^ WHEN PR PE Y ALIDATE THIS IS YOUR PERMLT
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SiGNATUREOFOWNERIIFOWNERBU�L E 1 IDATEI BLDG iNSP
f1aTE
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NEW [ i�}
ADDN. [ ]
u,T�t. L ]
City of Fridley
R-1 AAD R-2
Building Permit Applieation
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Effective 4/1/86
Construction Address: � �� �� ��
Legal Deseription:� ��.��' �,�� o=�_ �/ � �� s�-�=°t �� '�.��!, �,r2� �-�a �.�1��
lY,u���-f'e�� ����.���,� ,�z�-. a -
Owner Name & Address: �e �°��`°� `������ Tel. ����"��'�'� 0
Contractor: `�'/��- � z-� f°a C� � :� '�• .�� � Tel. # �.�r� °� -
Address: � � � `� ��-,0,<!/-� � � �,�� � � e� � ��i`�-i�� � s
LI9I�G AREA:
GARAGE AREA:
DECg AREA:
OTHER:
Corner Lot [ ]
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn oa it to scale.
DESCRIPTI08 OF IMPROYFMENT
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Length 3 6 Width � Z Height ° 2— Sq. Ft.
Length /. �' Width 2� Height /�- Sq. Ft. ��
Length `— Width Hgt/Ground---- Sq. Ft. '—
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Inside Lot � Ft. Yd. Setback 3 G Side Yard Setbaek �—' ��
Type of Construction: �-�� ° � � / d�� .� �'� �"�
Approu. Completion Date: �% � ��°� '
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Estimated Cost: $ -���
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o Alt. A Alt B
Progosed DriveWaq Width If New Opening Is Desired: � $ ��� $
See Baek Page for Explanation
DATE: � " J �—�� APPLICANT: �„�,���� � �a Tel. � �9`� "'�'r���
CITY IISE ONi.Y
Permit Fee $ Fee Schedule on Reverse Side
Plan Check $ '��i'�� 25� of Building Permit Fee
State Surcharge $ �.� � $.50/$1,000 Valuation
SAC Charge $ '•�� $525 per SAC Unit
Park Fee $ �i�� Fee Determined bq Engineering
Sewer Main Charge $
Agreement Necessary [ ] Not Neeessary [ ]
TOTAL
STIPOLATIONS:
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BIIII.DING PERMIT FEE SCHEDIILE
The Chief Building Official shall, before issuing permits for the ereetion of any
building or strueture, or for any addition to any existing building or structure, or
for any alteration or repair to any existing building or strueture, upon application
therefore, require the payment by the applieant for such permit of fees to the amount
herein below set forth and in the manner hereia provided to-wit:
Tatal 9aluatioa
$1.00 to $500.00
$501.00 to $2,000.00
Fees
$10.00 (Minimum Fee is $15.00)
$10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and ineluding
$2,000.
$2,001.00 to $25,000.00 $32•50 for the first $2,000 plus $6.00 for eaeh
additional $1,000 or fraction thereof, to and
including $25,000.
$25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $�.50 for each
additional $1,000 or fraetion thereof, to and
including $50,000.
$50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each
additional $1,000 or fraction thereof, to and
including $100,000.
$100,001.00 and up
$433.00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof.
DRI9EWAY DEPRESSION ESCROii
(Concrete Curb Streets Oaly)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus
6 feet times $13•50
Alternate "B": Removal and replaeement oF curb and gutter and install a 3 foot wide
approaeh with 6 inch depth - DriveWay width plus 6 feet times $15.75
VERIFICATION OF FOIINDATION
Permits for construetion 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 onee it
has been cronstructed will be required before proceeding with the framing.
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CA/NE � ASSOC/ATES
L AND SURI/E YORS, /NC.
/7120 Highwoy 65 N.E. - Sodervi//e, Minnesolo 55304
434 -7646
CCRT'IF'ICA1'E QF SUi2VEY F'UR: Don Chouinar:i
LEGAL GL•'5CItIP^.'I�a t •
Thet F�art Of LOt� 8n� 81� C2. .�fl�! kiS� F31pC}; A� kIVER ��IF.;•! Hf'I(:1lTS� hApk� CouDty.
Minnes�t�1, l��ing west oi thv �ast 90.00 feek of said Lots,
11nd, all th�t parf of th�� unn�m�.l ;;tr�:et. ��t,uttinq Lots 80, �1, u� ;,nd gs lviny
between tl�e Southerly line of Lot e0 exten<le.; :;csterly to the +t�
the �ortherly line of Lnt p3 extan�led l:esterly to the :•tAC kailroa�l�rlc�hta�p��way�
.as shown on the original m�p of s,,a� ;�iver l�iPw Heiqhts A�idition.
And, all that �art of the riqht uf v�ay of the Miiineanolla� qnQy1 ;,n� Cuvuns R�nc;e
Railxoad Company in the Southe�E� r�u�rter �f the yorthwest ��uarter of ��_.
Townshi�� 30 Yorth Ran��e 24 West 1�•in,� butween the ;Jorth line of Lot g;'��tion 3,
also Y.noan as Section A, Rivcr View tieic�hts, extended S�est throu�h s�ic: riciht of
, f:1 oc:. A ,
way and said South line of•Lot 80, ,;l�ck 4, ;+iver ✓iew Ileicihts, ext��nde�3 •,est
through said riqht of �•;a•1 icc�rriin�! tc� th� olat theraof nn file and oE :c•c;or.l in
, the office of the c.•ounty Rncorricr in :in�l ior Anol:a c;ounty, :linne:ota.
thereof,tandaalsonover�thetwest 17,�50tfeetYthPrcofee °ver the'�outh 12.00 feet
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CITYQF
FRIDLEY
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
August 7, 1987
Mr. Richard Tkacz3k �
Rfichard Tkaczik Construction Inc.
12323 Gladiola N.W.
Coon Rapids, MN 55433 �
Re: Verifying Surveys for 441, 451, and 461 Hugo Street N.E., Fridley
Dear Mr. Tkaczik:
�'inal inspections have been made on 461 Iiugo Street, and are yet to he made
on 441 and 451 Hugo Street. W� have not received the verifying survey for
any of the addresses and it was a stipulation.on the liuilding permits which
must be complted witli.
We will expect the verifying surveys to be submitted to us by September 1,
1987. Further inspections for final approvals will not be coazducted unless
the surveys have been sul�nitted.
If yoai have any questions on this matter, please feel free to contact me at
571-3450. �
Sincerely, .
DARREL G. CLARK
Chief Building Official
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� THE BELOW MUST BE FILLED IN WHEN REPIACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL 6E RE'TURNED
�e� �..�.,� �n OYieiin� furancE, the undersigned hereby verifles that the
ven�ng has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required.
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination.
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes ai C ntrai fFumace V nti gCTables fo' fanoes
include AGA-GAMA Category
assisted and naturai draft appliances.
__,..,..,h� ��t�en s�r is sized and installed to meet the current codes
The E�tl'--- - -- -
and manufacturers specifications.
When required to ' ' it will be si�ed and installed
to meet the current codes and manufacturers specfications.
When � � m� the undersign�d hereby verifies that
it is a listed assembiy and meets the current codes and �na ena�ctu umace
specifications. This does include AGA-GAMA Catego n�
Ven�ng Tables for fan assisted and natural draft app
Is the common vent an e�ov d from the co monv nt aind ented�y after
an appliance has been
separately as per current codes.
Appliance #1 Type �����-� - BTU Input � S, vn'
Appliance #2 Type �-���-t-��� BTU Input � N, �
Applianc� #3 TYPe BTU Input
Total Appli��S ----_ _ Total Btu Input -
Vent Height �U r Diameter .� �� inches
Yes (xl No ( )
Yes (XI No ( )
Yes (�) No ( }
Yes � ) No ( ) --
Yes � ) No ( )
Yes {� ) No ( )
Yes (x) No ( )
an Assist d or Na �
Fan ssisted or at
Fan Assisted or Nat
Common Vent Type �> � —
qppliance #1 Vent Connector Height ft Len9th � ft Diameter Y" in
App l ian c e # 2 V e n t C o n n e c t o r H e i g h t _� 9---
Appliance #3 Vent Connector Height,= Length ft Diameter i n
Type c /_ '�
Type �
Type �
,CenterPoi 13562 Central ve NE, Anoka, MN 55304
HEATING CO• � _
- ' `""` 1 � i ' .
.
. : . -- `• :. �:
.�,;..-�.
C�il+�oint�
E�rerg�r
Minnegasco
ADDRESS � � c� � r 4�� e� �-
OCCUPANT� eDrvr� �c, rr, . �
HEAT LOSS_ Yes DATE HTG. INST.
SOLD BY— _ CenterPoint Energy Minneaasco
Electrical Work By —�-
TYPE OF HEAT FA SPACE HTR.
HOUSE �9�TING TEST RECOFfD
APT. FLOOR CITY�I �
OWNER ��
INSTALLED BY
Gas Line By
UNIT HTR. OTHER
� �V � �e►s ��si�N co�ve�sio�
MAKE �,�
Model _� f r P'� (�1'� = U Vent Size
ser� �n _�� � � f�R Z� KfND OF LINER � +� �, � sizf �'
NPUT 7 S. O?)D ���yE
Draft Haod Regulator
ONTROLS Fflters Size /Co�{�J 1C � Number �
THERMOSTAT � i....-.. � Heat Plug Chimney Location inside X Outside
Value Chimney Construction _%� Vc,,�-�.
Umft Setting 17
Fan Settin�
Pilot Type
Pilot Make�l�
Pilot Model�
Ptlot Timing �/ S.SE C-
Pressure , S Percent CO2
nput CFH_� ��b Percent 02 � sq
Stack Temp. � � �� Percent CO �
1Aliring �
Test Tag �
LighUng Inst. �
Date Tested
Company Testing n r' r inn
Name of Tester �r�
�IEW
�DDN
aLTER
��OS - vId d �
� � CITY OF FRIDLEY
�� 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bidg insp
�� SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
� BUILDING PERMIT APPLICATION
Construction Address: '�� � � � f K� c
�-� / �.% G�
Legal Description:
Owner Name & Address: /►��� ^� �'' S �«�� n�r 4� St l� �� a Sr— Tel. #��2 3 Z q a��- 4s
Contractor. MN LICENSE #
Address: Tel. #
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certficate of Survey of the
bt, with the proposed construction drawn on it to'scale.
DESCRIPTION OF IMPROVEMENT
Length �dth _ Height Sq. Ft
Length Width Height _ Sq. Ft
Length ,_,_ �d� Hgt/Ground Sq. Ft
�� �Z�-� �- ��o �S e ��- �6ceL � � � C 8' s� ���_� � f� ���.
Construction Type: Estimated Cost: $ ' 1� r��
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _ _$
� � zq� � �-�LS
DATE: � ^ � .� APPLICANT: Tel. #� 3
Call (763) 572-3604 for Permit Fees if mailing in appiicaiion. Fax to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
� C°3-��
$
� �. a r
� /• ��
$
$
$
$
$
$
� � � ���
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50!$1,000 Valuation
$1450 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 [ ]
STIPULATIONS:
BUIIrDING PERNIIT FEE SCHEDTJY..E
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addidon to any existing building or structure, or for any alteration or repair to any e�sting 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
$1 to $5�
$501 to $2,�0
$2,001 to $25,�0
$25,001 to $50,000
$50,001 to $100,0�
$100,OD1 to $5�,�
$500,�1 to $1,�,�
FEFS
$23.50
$23.50 for first $5� plus $3 .OS for each additional $100 or
fraction there�f, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,0�
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,0�
or fraction ther�f, to and including $50,000
$643.75 for first $50,�0 plus $7.� for each additional
$1,�0 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 $5(10,000
$3,233.75 for the first $5�,000 plus $4.75 for each additional
$1, 000 or fracdon thereof, to and including $1, 0(�,�0
$1,OOD,�1 and up $5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fracdon thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet times $20. Q0.
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 construcdon site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be require� before
proceaiing with the framing. New Houses Only
Building pLjJ��G Pe�it 1�to.� -
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY � D� R�'a: -�
DATE YOUR EaV1AIL ADDRESS •
srrE �wDt�ss Saw�c o�s Q�•�t•� E1dalNorman Scmidt
THIS APPLICANT IS: ❑ OWNER �CONTRACTOR
PROPERTY 451 Hugo Street Northeast
N�� Fridley, MN 55432
O�� �D�s: 7637924295 '. TATE �
TENANT
• PHOATE:
corr�nc°roR N,�,,,�. NOR�LOM PLUM6ING CO,
STATE LICndSE �l�' O�S ra � ����_n��
SUBMIT A COPY OF -r� ..�. -*
YOUR STA'TE ADDRESS: ,G STATE ZIP
LICENSE WITFi ��.• • •
PHONE
APPLICATION °
PERMIT TYPE �SINGLE FAMII.Y ❑ TWO FAMII.Y � TOWNHOUSE
TYPE oF woRx: � �w . . t�(xEr�,c�rrr .
DETAILED DESCRIPTION OF WORK RttDlac.t GIJa�L✓ /S%a�t✓
� PER MS 16B.665 the gerniit fee is a miuimum of $15.00 or 5% of the total cost up to $500.00; whichever is greater, for the
improvement, insrallation or replacement of a residential fixture, excluding the fixriues. (This shouldreflect only.ihe cost of labor )
Lahor cost under $300 =$ I5.00. Labor cost between $300 tq $500 = cost Qf Iabor x.OS =
,: :-.FOR:�ROJECT�S WHERE LASOR EXCEEDS$SOO;�EE.S ARE BA3ED ON $10.00 PER FDZTURE,�EXCEPT'sVJ�xENQ'I�i�.:RI�Ci�E�:�.(�WDiGATE TOTAL
NUNIDER OF EACH BELOR�
BATH SINK/IAV FL40R DRAMS • SHOWER WATER PIPING
BATHTUB GAS P�ING ��vcmucovvsE) SWD�RMDVG POOL WATER SOFINER ($35)
CLOT[�S WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
DISHWASHER _�LAUNDRY TRAY �WATER HEATER ($35) FOR IRRIGATION
WATER MEfER OTHER
� "°9 " _ ..'.'ea. - _
Permit Fee $ Number of fnctures @$10.0U x$10.00 =$
Surchar e .50 Number of ftxtures @$15.00 x$15�00 =$
TOTAL DUE $ ATumber of fixiures @$35.09,� x$33.00 =$�
.. State Surcharge = $ .50
Total = $ s: SD
THIS IS AN APPLiCAT10N FOR A PERMIT-NOT VALID UNTA. PROCESSm �
I hereby appiy for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in
conforma�cce with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that T understand this is
not a pertnit but only an ap 'on for a permit and work is not ta start without a permit; that the work will be in accordance with the
approved plan in the case work wlu requires review and approval of plans.
SIGNATURE OF APPLIC PRINT NAME �el / Oi�llOK�I DATE
y. _
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
^ ' B:�,zilding
� Inspections
763-572-3604
763-502-4977 FAX
na�. �.� _ �• �
srrE annxESS y �
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATL LICENSE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING DC
SIZE OF IIVIPROVEMENT_
ROOFlNG
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Viayl
❑ Altm,inum
❑ Other
BUILDING `
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR
�t��.. / � J��t1 '
, — —
■ • �i, • •'
i• � � � 9r � /_Ia7�1
. ��. �, ,'
� � �
' ��,� _
. �
�//L�l�Q�
— ��
�_ �..�.� �
„ , _
�, �- -, : �
� , _ �- �� � ��
PIiONE lo.S% — � ��- alo � � - - _ FAX — - _ _
STATE LICENSE # �%S� � EXP DATE ��� �
�INGLE FAMII, ON
❑ TWO FAMII.Y/NEW CONSTRUCfION
❑ BASEMENT FIIVISH ❑ ROOF
❑ DECK ❑ SIDING
SIZE
STORIES
❑ SWINIMIIVQ POOL
HOME CONSTRUCTION ❑ ADDITION
ITENANCFJREPAIIt ❑ REMODELING
ti
—P
LENGTH WIDTH
❑ HOUSE ONLY
❑ HOUSE dt GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
�Ti�i�TBtiV✓S
IN EXISTING OPENINGS es ONo
OR FOR NEW OPINING -DESCRIBE SIZE OF
OPENING CHANGES 8c
TYPE OF WINDOW TO BE INSTALLED
TOTAL JOB VALUATION
Permit Fee
Plan Review
, Fire Surcharge
', Surcharge
License Surcharge
SAC Charge
Curb Gitt Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Dne
�Sotiit
o T� 3_ �(Q-rr, . �
o F� �_ ��Cs.�.A-r.
LOCATION OF WINDOWS a. — .�^r"�-
❑ DRAIN TII.E
0 o�x
Ff
BASENIEN7' REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structwal members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
,ADDITIONS. Bc PORCHES SUBMTf:
1. Site Plan/Siuvey showing the existumg strucbues
and proposed project.
2. Two sets of conslruction plans
3. �n�rgq t�icvTafiiaa� -
ON VALUATION, INCLUDING THE COST OF LABOR AND
�� �(USING'1'HE 1997UBC FEE SCHEDULE)
7�YJ. � ()C'C'iTPAN[:Y
$ /,-�S �f. �7 See Back Page for Fee Schedule
$ 65% of Building Pernrit Fee
$ � . 7� .001 times the total job valuation
$ 3,�v .0005 x Permit Valuation Minimum $.50
$ S • � $5.00 (State Licensed Residential Coniractors)
$ $1825 ger SAC Unit (Plans to MWCC for determinarion)
$ f}+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( ) �_
$ • Make checks payable to: City of Fridlev • Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building pernut and I aclrnowledge that the inforanti n above ia complete and accurate; that the work will be in conformance with the ord'mances and codes
of the Ciry of Fridley and with the Minneso nsUUC�tfon Codes; ttwt underatand this is noY a permit but only an apglicatyon f r a pei3nit aad wark is not ta s4act writhout a
pemtit on site; that the work will be in rdance ' the approved p in case of all work which requires ew an v of lans.
SIGNATURE OF APPLICANT PRINT NAME � DATE� ��O /
APPROVED BY DATE