AF - 46708City of Fridley, Minn..
BUILDING PERMIT
N° 59'75
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— � ��
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pwner: Builder _..—_�_ _...___._.__.�
Address _ .— Address — — —
— � ' LOCAT O UILDlIeDG
� - ._
No. ��jD�,,�_ Street �'"� -�—� Part Lot � ---�--
Lot . �...��__ Block ......— Addition or Sub-Di �on _ _ .�,,�'�''�G�-,��r" �".�'y—
Corner Lot _. Inside Lot �...�— Setback ���_. Sideyard _���
Sewer IIevation _____^ ._ Founda.tion IIevation
DESCRIPTION OF BUILDING
To Te Used as: ' !� %/� �r/� Q�
Front � Depth _�r�'_tL Height ,_,,,�,� Sq. Ft r�_L—�" Cu. Ft �i��
ron Depth Height —.—��ci. F't. — Cu. F't.
Z�pe of Construction Est. Co'st �...�,....� =�be Completed
Ia consideration oP the isauance to me of a pernut 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 oP
ordinances of the dty of Fridley.
�
In consideration of the payment of a fee oE $.�--•, Permit is hereby granted to
to construct the building or addition as described above. This permit is granied upon
the express condition that the person to whom it is granted and his agents, emPloyees and worlunen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maiatenance, repair and moving of buildings
'witUin the city limits aad this permrt may be revoked at any time upon violation of any of the provisions of said
oTdiri8IICe8. �""' ., �
Bl]i1diII$ IIISpeCtOr
NOTICE:
T6is permi� does no� eover �hs aoa�trueNon, lnstallaHoe for wfeing, plumbine, gas heatinp, aewer o� water. Be sun to w
th� Buildtag lespsetor for aperate permht fo� theas hams.
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._-_ a
APPLICATION FOR BUILDY1dG PERMIT ,
CITY OF FRIDLEY, MINNESOTA ;
;
,
Owners Neme �i>�� �'7 �' ,�' �+�.�a�'/° .� �� ilder�l��� �% ���°' %�i��=`�� � /�' ,
Addreas �'� � � �� �A �=��.�_Address �,�Y �� �� �° ` /� ce f �T i�� �� ,
� LOCATION QF BUILDINa ''
No.
of Lot
Lot � 1� ,� Block � Asldition or Sub.Div�„�� ��i��t�� 1�' i'f.�-���t%T�
�..:....�.o�.�—
0
Corner I�ot�,Ins�.de Lot__„�,Set Back�,�_� ,Side-Yard ���'�,�.,,_
�.. _ -.----�--
gEy,�, II,���p� ' � FOUNDATION ELEVATION_,w_____, •
Applicant attach to th3s form Certificate of Suxwey of Lot and proposed building
location.
DESCRiPTION OF BUILDIAIG
To be used as:
Front �� � Depth . � �`` Height .�° �-
�. Ft. �° /��. Ft. � �
Front Depth He3ght
Sq. Ft. Cu. Ft.
Type of Conatruction I�stimated Cost �_, �`��w
To be
The undersigned hereby me.kes application�for a permit for the work herein apecii'ied,
agreeing to do al1 work in strict accordance with the City Ordinances and ruling of
the Department of Bu3ldings, and bereby declares that all the facts and represents-
tions ste.ted in thia application are true and correct.
� i-t `` ,/ . �
DATE �`����� �. SIGNATURE � �`� � �
(A 5chedule of Fee costa can be found on the Rever�e 3ide.)
_ . - :� � � � � �
. _ n , w_ � �. � � ��, �- ' �.� r�
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: 1 1 1 '�' 'M JI � 1�1 I�,r
Section 2, The Inspector of Buildinga shall, before issui.ng ang perm3.t
for the erection of e,n� bu3lding or structure, or For any addition to
an� existing building or structure, or for any alterations or P8p8.j.PS
to any existing building or structure, upon applica.tion therefor� require
the pa,rment by the applica,nt for such permit of fees to the amount herein
below set Forth and in the manner herein provided to-wit:
2.1. For any such perm3.t for the erection of any fire--proof building� other
than a gaxage, warehouse, factor�r or grain elevator, or for the erection of
any fixeproof addition, for s3.milar occupancy, to any existin� buildin� �
shall be at the rate of �1.40 for each one thousand cubic feet, or fract3on
thereof, in such cubical contents.
2.2. For any such permit for the ereation of any fireproof garage, ware-
hous�, factory or grain elevator,�or for the erection of any fireproof
addition for similar occupancy, to any existing bu3.lding shall be at the
rate of �1,25 for each one thousand cubie feet, classified as "f3reproof"
by Section 502 of the Minneapolis Build3.ng Code.
HO�E3
2,�. For any auch permit for the erection of an
other than a garage� warehouse� factory or grain
fireproof addition, for similar occupancy� to an
Permit �1..00 for each one thousand cubic feet.
GARAGES
y non-fireproof building
elevator, ar any non-
y existing building.
2.4• For a.ng such permit for the erection of any norr-fireproof garage,
warehouse, factory or grain elevator, or for the erection of eny non-
fireproof addition, for similar occupancy, to ar� e�d.stin� buildin��t'
for each such building or addition. Ninety Centa for ee.ch one thousdnd
cubic feet or fraction thereof, in the cubical contents thereof with a
minimnm pf �`,4,,,00�
For the purpose of computing fees for building perm3.ts the cubical contents
of �.ny building or addition to a un3,form height throughout by mu].tiply3.ng
the ground area covered from a point six (6) inches below the f'loor 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 repaixs or alterations to an exiating structure, the fee shail be
at the rate of �3.00 for each Five Hundred Dolle�'.� ($500.00), or f�action
thereof in the cost of all proposed work.
2.6. In no case shall the fee charged for any permi.t as set forth in
Section 2 be less than �..00.
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I FIERL�Y CERfIFY THAT TF�S IS A TRUE AND CORRECT .REMlE�BJTATION OP A SURVEY OF THE lOUNDAIUES OF -il# AOOVE -
DESCRIlED LAND, AND THE LOtATtON OF ALL 6UILQWGS, THEREON, AND ALL VISIBLE BdCROACHMB�ITS, !F ANY, FROM OR Q�! SI11D
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/1S SURYEYED �Y ME TFpS ,?,th...... DAY OF .....:................. �Jl]I1C....................... ...... /1.D. 19, f` Z
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City of Fridley, Minn.
BUILDING PERMIT
N 6289 ..-`��
Date: � � � �� ` id �
Ownertf ^ �— Builder � � { "�
Adc]ress
Address
LO I BUILDING
No. � Street ��r�!��� p� t
_ '� ' � � , '
Lot ���_ Block — Addition or Sub- an �� f
Corner Lot _ Inside Lot ��— �back ' u.._ Sideysrd �.�
Sewer IIevatian � Fo dation IIevation
DESCRIPTION OF BUILDING
T Use@ as: %��
� Front � Depth _,�� Height �_:�L-. S�i• E't. y�� Cu. F't .��..u+�'
Fro t Depth ,°' ITeight � S�l. F't. Cu. F't.
Type of Conetruction ��,�"—"�-'`�-- Es� ---' T�--� "'�� To be Completed — ---
�
In conaideration of the issuance to me of a permit to construct the bwllding described above I agree to do
th� proposed work in accorda.nce with the description above set forth and in compliance w1th a�l Provisions of
ordinances oP the dty oE FrYdley.
�
In c�sfderation of the payment of a fee oP �_�� , permit is hereby granted to
to construct the buflding or addition as described above. This permit is granted uPon
the express condition that theperson to whom it is granted and hia agents, employees and worlunen, in all work
done in, around and upon said buildiug, or anypart thereof, shall conform in all respects to the ordinances o4
Frldley, Minnesota regarding location, constructfon, alteration, maintenaace, repair and moviug of buildings
within the dty limits and this permit may be revoked at any����+iolatioa� aay of the provisiona oY said
ordinanc�s. j
Inapector
NOTICE:
'Ihis p�rmh dws nof cowr fh� eoasMreNoe, InaaOa�ioe fer .rl�ino. 'lumbtno. �.s 6.a�a s.vnr oe Wa�.r. B� wn to a�
t6� Bnildieg In�e�ae for apuaf� �its Poe t6�a tt�mt.
- � . —s � �
;;� `� ,�.F _
.�-, -
� � `
s
�PPLICITION FOR BUILDSNG PERNQT
CIT3t OF FRIDLEY, MSNN�SOTA
OwneTB Name �•�omas C. Sorensen Builder,� MILES CONS�ItU�TiQj�j„C4 '�_._,...
��e9� 631 Hugo N.E. Fridley A�dreee 4500 Lyndale No. Mg1_s^.,12_ M�•.
LOCATION OF BUILDING
�o� 631 Stree� Hugo N.E. , Part of Lot
Lot 7& 8 Hlock ,�_, Addition or Sub.Div. Rivervie� Aei ts ,�,�d�tion
Anoka CounCy
Corner Lot_,Inside Lot_____ 3et Back Side-Yard
SEWER ELEVATION FOUNDATION EI�EVATION _ _�,_,,.,�_
Applicant attach to th�s form Certi�icate of Survey of Lot and proposed building
location.
DESCRIPTIOIV OF BUZLDING
To be used as: �
Gara�e Front 18 DePth ?2 ... . He3ght —?=-------
Sq. Ft. Cu. Ft.
Front Depth He3ght _r,�„_,_,,,_
�. Ft. Cu. Ft,
'I�rpe of Construction F�� Estimated Gost 5�,��0.0c� —
To be completed As soon as gassi.r�e ---
3'he undersigned hereby makes applicat3on for a permit for the work herein apecified,
agree9.ng to do all work in strict accordance with the City Ordinances and ruling of
the Department of Buildings, and hereby declares tha.t a11 the facts and representa-
tions atated 3,n this applica.tion are true and correct.
.
nA� ._, d �— � � - G �- � szc�vxE
(� Schedule of Fee costs can be found on the Reverse Side.)
�,� �
� � � �, ,d.
i��
�
, . BIIILDIlVG PERMIT FEE SCHIDUZE
Seet3.on 2. The Inspector of Buildings shall, befbre issuing any permit
for"the erecti;on af any building or structure, ar for any addition to _
a.ny existing building or structure, or �or ang alterations oar repa�.rs
, to any ex3.sti.ng building or structure, upon application therefar, require
-,tYle.pa.�ment by,the applicant for such permit of fees �o the amount herein
bei�r set -farth �nd in ��he manner her��.n prov�tded' to�w��t: �� ���
_ �� ' 2.�:�. ' For � any �suc�. perini:�" for the erec�ion of any i°ire-pi�o°of �u3lditig, other
than a garage,' warehouse, factory or grain elevator, or for the ereetion of
a,�y , fireprQOf �add3.t3.on, .fo� simi.lar : a�.cupanc�r, ..ta any �xsting build3ng, _ _
- - ; - �. ��sh�:�. i�e, a`� t�e--�ra�e- o�- �7: :4(�. f or. :e�afi �flne thousand, �cub3:B� �eet, or �'ract�on
'thereof, in such cubica7. contents. , , ,,
,.__.: _::,2.;2.. ;�Fpr .any sueh permit for the erection of any fireproof garage� wer.e-.
hous�,:factoxy,ar grain elevator,'or far the erection of any firsproof :' '
addition, for similar oceupancy, to any existing buiTding �hall be.at.the
rate of �7,.25 for. each one. �housand cubic feet, classifie� as '�Pireprdof'�
by.5ection 502 of.the Minneapolis.Buil.ding Code. � �
HO-��
2.3. For any such permit for the erection of any non-firepr.00f building
o�tlier than e garage, warehouse, factor� `or gra3.n elevator, or any non-
fireproof addition, for similar occupancg, to any existing bui].di.ng.
=Permit �..00 for each one thousand cubic feet.
�,� �.
_� t:�
�, _�
� . .:.: . .
_ 2.4. For �a,ny such permit for the e�ection of any no'n-fireproof gaxage,
`�' warek�ouse, factory or grain elevator, or for the erec�ion of any non-
fireproo� addition, for similax occupancy, to a.ny exi.sting building.
for each such building or addition. Ninety Cents for each one thousa�nd .
--_---���e--��'�-er�-f�c�ia�=--��Sree�'; �in-t�:�- cubico�'L.. "con�en�s �fie�eo�i��h a�"�A ;� ._ _ _ _
,: minimu� of , $r�..00.
For the pnrpose of computing fees for bui.lding permita the cub3cal cante�ts
of any building or addition to a uniform hsight, tY�x�oughou� "b�r multiplying
the ground axea covered from a point six (6) inches below the floor lins of
the ba.sement or cellar to the average height of the upper surface or to the
average hei�ht of the roof surface of the main gable of a pitcYted roof.
,
2.5. For r�pa3rs or alteratiens to an existing atructure, the fee shail be
�.t the rate of �3.00 for each Five Hundred Dollar:� (�500.00), or fraction
thereof in the cost of all proposed work.
2.b. In no ca.ae shall the fee chaxged %r any permit as set Porth in
Section 2 be less than $�,.00.
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City of Fridley, Minn.
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PERMIT N� s � o �.
�
Builder
Address Addrese
LOCA OP �JILDING
No. street .�.t P LPt
Lot �__ Bloclt Additian or Sub-
Corner Lot _ Inside Lot � �Iwlback Sideyard
Sewer IIevati� ____— �� Fo tfon IIevation
DESCRIPTION OF BUILDING
T as:
F'ront ��.. Depth �.�... Fleight �� Scl• F'����� �' F��,��
Depth � ght S4. F't. Cu. F't.
Type o4 Conetruction ^� Es�,r` ���--�To be Completed ---
�'' -
/ �
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� � ���� l�
(P� � �
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In consideration of fihe issuence to of a permit to construct the building described above, I agree to do
the proposed work 9n accordance with the descriPtion above set forth and in compliance with a11 Provislons of
ordinances of the dty oP Fridley. �
In comsideration of the payment of a Pee of ��—''"�� , permit is hereby granted to
to construct the buflding or addihon as described above. This permit is granted nPon
the express condition that the person to whom it is granted and hia agents, employees and workmen, in all work
done in, around and upon said building, or any gart thereof, shall conforai in all reapects to the ordinances of
Fridley, Minnesota regarding lacation, construction, alteration, ma3atenaac�, re�ir and movu►g of buildinga
o��� dty limits and thia permit may be revoked at �,,�e�� viqla'11� of any oE the P��ons of aaid
/� �
Building Inspector
NOTICE:
iWs psrmH doa eef eonr fiu comtrueHoe, Iesnll�Hoe ier vrirh�o, �lumbtno, �a h�y, shw� ee rratar. B� wn to a�
fh� 8n(Idi� lesp�etor io� aparaH p�rmih ior fh�a N�ms. �
..��, .
/�, •.,�c � - �r _
.� �L r� �
`r'' �"' .— � -.e
_. � � .«
Owner's
��.
APpLICATION �Oia Bt7Yi�DTNG PERI+�IT
CiTY AF FRI:DLEY, N�SOR'A �
.
LOCATION OF BUtLDING
�� .
� a �
s �5V/ G� -�; �,n��'�-.C:`�= � ��-�
��� ��
�To, �-� � Street J�-�-� � Part o�' Lot �
,__...�.._.__.__..... ,�.
�J C .�e�--.� ,'��''
Lot ��� Sloek '� Addition or Sub ivision
Ii ��/��P�I��r��q�� . ���
Cornar Lot in�ide Lot Setback _r 99.de-Yard
SEGdEIt ET�EEVATION i'OUNDATION ELEVATIOI�T
Applicant at�ach ta �his forna Certi�ieate of Surv�y of Lot and
propo�ec� buildang location.
T� o be used as o�
,.
DE��YPTiON OF HUILD?NG
�q. Ft. Cu. Ft.
t
Front� Dep�h ,._,= eight
Sq. L�t. Cu. �'t.
�� � :
Typ� of Construction `���->�-= Est�,mated Cos� ��°-� �
�o � be comp].ete8 �� ��„ , _ _ ._ ,
The undessigned hereby makes application for a permit iEor the work
harei.ri epeci�ied, ag�eeing to do al.l work in, str�,cst accordance with
�he C�.ty of Fridloy O�cdinances and ruling o� the Department o� 8uild-
iMgs, and heseby declares,that aZl the faote and representatione
atated in thi$ application, are true and co�crect. �
�
DATE `�'�`� �-�' �Z G^ ' STGkVATU�iE ��� �_���:.' jiJ, ��, ,'`9,��-��--
�. ...��...��..� ...�.�����...�r�..�
(Schedule of ��e Costs can be. iound on the Reverse`�ide).
,.,. , , ,:; P"�
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�UILDTN'G PER�IIT FEE SCHEDULE
section 2. The Yns,�ector of Buildinc�s shall, befoYe issuirag any
par�►ii:. �Eor the erec��aon o:� any building or structure, or fo�t any
addition to any ex�.s�in� building or s�t•ruc�utce, or £or any . a�.tera�ions
or �epairs �o any axis��.ng build3.ng or si:ructure, upon appaicat�.on
..�he:r�e�or, require the pay�aen� by the applicant for such pelcmit of
fees �to the amount here�.ri below set �orth and in �he manner here�l..n
provided to wito �
2.].. �or any such p��mit ior the erection of any fire-p�oo:� building.
o�her than a garage, wa�cehouae, factoscy or grain elevator, or �or the
erection of any ��tre-p�oo� acldition, for sim�.lar occupancy, to any
exis��ng building shall be aat the ra�e of _$1.40 for each ona thousatid
cu'�ic �eet, or �raction thereof, in such cubical contents.
2.2. -•For any such permit �or the erection or asiy �Eire-proo�' garage,
i�a�eliouse, gactory or grain elevator, or for 'che erect3oii ox ar�y f3re--
proo� a��3.tion, �or sii�ilar occupancy, �o any eaciating bu�lding shall
1oe at the rata of $�..25 ror each one thousand cub3c iEeet� �cYassifiecl
as "�ireproo�" by �Sectioa 502 0� the M�inneapolis Build�:ng Code.
HO.... USES
2_.3. For any such perm�.t for the erec�ion of
�.ng othe= than a garage, warehouse, fac�ory or
non-�ireproo�c addiic�.on, �or similat ocoupancy,
Permit $1.00 for each one thousand cubic feet.
�GE9
any non- f 3�ceproo� build-
grain elevator, or any
to any exis�ing bu�.lding
2_�., �or any such pescmit �or �he erection o� any noa�-firep�oo�
garage, wa=ehouse, ractory or grain eleva�or, or for the erection ofr
any non-fireproof add3.tion, �Eor a�rutlar occu,pancy, to. any exist3ng ,
builcAing cr for each such building or addition. ATinety Cen�s �or each
one t�iousand cubic feet or iEraction �hereo�, in t,he cubical contents
tliereof wi�h a minimuiri o� $4.00.
�or the purpose or compu�:ing fees for building permi�s the cubical con-
ten�� of_any building or addition �o a unifo��n he3.ght throughout by
multiplying the ground area covered �ro�n a poin� aix (6) inches bexaw
�the floor 3ina� o� �he base.naent or �ella:� to the average height of tlza
uppe�c surface or �o �che average heigh� os the�roof surface of the maia
gable of a p�.tched roo�.
2� 5. For repairs or alterations to an existing structure, the fee
shall be at the ra�e o� $3,00 per each Five Hundred Dollars ($500.00�
or �-raction �thereo� in �tize �cost o� all proposed work,
2� 3n no case shail �he �ee chaxged zor any permit as s�t �Eorth in
Secti�.��e lees tYr'� $4.00, �
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City of Fridley
r ar TNE TOP 0► TME TMnNi
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� . �! i M!Q'T�CTIVR NfI��CTIpN OtK,
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i...�«J`.� .J N�'��0^3M0
Job Address
ner
Contractor
Kind of Buildin
Comp etion Date
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631 R1. E. Hu�o
R. Z�ch
MINNEGASCO
Fra�
53-$4-879.01
i�JECT
, � �i�o
PLuMBI�Vr, PERf�IT APPLICATI���d
R A6V. pATE ►�E 01 • OV 0 8�
- o z i5 3 1 � 1 800
.
Ad ress P one
re�3� MAftQUETTE AVENUE P one
Use ., .
R�s. '
stimate ost �
10-17-73 • 10.00
i �' �� � Plumbing Fixture Rates: N0. RATE TOTAL
� ; il
—� ---;: ! Number Fixture� x $2.00 fiy__
I:
I�� I! I� Future Fixtures x$1.50 '
m
, , �I;
; � •� "; New Fixture-Old Open. x$1.50
i � �? Catch Bastn x$3.25 I��
I ; f I
ii�� � Water Heater-99,000 BTU x$3.00 '�
I � �
� Ground Run Old Bldg. x$3.25
I--i � I� �
Elec. Water Heater x$2.00
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Gas Fitting Faes:
lst 3 Fixtures x $2.00
Additio - x $ .75
Gas Rang , � x $5.00
Repl Range
Regeirs � Alterationa
See
Deacription: Code 3.�p
S tate Surcharf�e ��� �'�� �urcharge �50� . 50
TOTAL FEE $ 3.50
!The underaigned hereby makes application for a permit
for the work herein specified� agreeing to do all work
in strict accordance w�th the City Qrdinancea and rulin�
of the Department nf Buildi.nge, and hereby declare that
a1l�the Facta and reprasentationa atated in thia
appl�i tion are true and correct.
._
.�' ��,,� �°. . �.
� i cmA ture � Date
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FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNIWG APPLIANCE PERNIITS
COMMON VEMT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When repiacin� an exist�na furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The ver�ting system is �olasticlPVC and meets all current codes and manufacturer
spec�cations including sizirag, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit is a lisfed assembly
and meets the current codes and manufacture�s specific�tions. This does
include AGA-GANW Category I C.errtral Fumace Venting Tables for fan
assisted and natural draft applianc;�s.
The existinq combustion air is siz� and installed to meet the current codes
and manufacturer's specificafions.
When required to install a new combusfion air it will be sized and installed
to meet the current codes and manufacturer's sRecifications.
Yes ( ) No ( )
Yes( ) Noi )
Yes ( ) No ( )
When irtstallina a new ven�ina svstem the undersigned hereby verifies that
it �s a listed assembly and meets the aaRent c�des and manufacturer's
specifications. This does indude AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. y� ��
Is the common vent and verrt conne�tors sized and installed correctly after
an appliance has been removed from the common vent and vented
separaiely as �r current codes.
Na ( )
Yes ( ) No ( )
Aapliance Tvae and Size/Common Vent 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 Nai
Total Appliances Tatal Btu Input
Common Vent Type Verrt Height Diameter inches
Applianc� #'t Verrt Connecior Height ft Length ft Diameter in Type
Appliance #2 Vent Gonnector Height fi Length ft Diameter in Type
Appliance #3 Verrt Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describ�)
HEATlNG CO:
Signed By: Date :
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Building BUILDING Permit rro.:
Inspections RESIDENTIAL APPLICATIC)N R��ved By:
7b3-s�2-36U4 CITY OF FRIDLEY '��'�!�► � 0
DATE YOUR E-MAIL ADDRESS
SI'fEpDpRES,q 831 Hugo Street
THIS APPLICANT IS: O OWNER �CONTRACfOR
PROPERTY OWNER! NpM� Oetaneh Aaneke
TENANT ADDRESS: CITY STA'fE_lIP
PHONE:
CONTRACTOR N�: Cedar Valley Exterlors
SUBMIT A COPY OF STATE LICENSE # Zol»z85 EXP DATE 3/as/zooe
YOUR STATE LICBNSE ADDRESS: 1700 93rd I.ane ne CffY e�ame STATE mn;,,p�55449
WITH APPLICATTORI pHONE �637552221 gp}� 7637555390
PROFERTY TYPE O SIIVdLE FAMII.Y/NEW CONSTRUGTION SIZE
O 7W0 FAMII.Y/PfEW CONSTRUCITON STORIES
PERNllT TYPE ❑�AiTION ❑ CaaltAaF�SHED � WRdDOws
Cl BASEMENT FINISH �ROOF O DRAW TTLE
CI DECK �S[DING O OTHER
O SWIMMIN(3 POOL
TYPE OF WORK: 0�H' ❑ ADDITION
❑ n�an�rrErrArrc�,vR o x�onE�.n�rc
DESCRIBE WORK BEING DONE: ZZBq re-roof
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S. Ft.
RQOFING O HOUSE ONLY
NUMBER OF SQUARES _ ❑ HOUSE & GARAGE AASEMENT REMODELING SUBIVIIT:
GARAGES Q ATTACHED GARAGE �• �j��8 Floor Plen
PROPOSED SI�: 0 DETACHED GARAGE Z• ProPosed tloor plan
PROPOSED HEICiHT: 3. List oT strucwial members to be used
SIDIIVG FOR NEW CONSTRUCT10tV INCLUDING DECKS,
O Vinyl ❑Soffit ADDi7IONS. & PORCHES SUBMIT:
O Alwninum O Trim 1. Site Plen/Survey showing the esisting struct�res
� Other � Fescia endproposedproje�x.
�N�W3 2. Two sete of consuuetion plans
IN EXISTIiJG OPEN�IGS ❑Yes ONo LACATION OF WIlYDOWS 3. Energy Calculatro�
OR FOR NEW OPENINGS-DESCRIBE $IZE OF
OPENING CHANGES &
TYPE OF WIIVDOW TO BE AISTALLED NIJNIBER OF WINDOWS
ALL FEES ARE BASED ON VALUATIOIV, IiVCLUDIIV4 '1'H�: (:u��r ur� �us�K a►vu Mwrr:iuAw:
(LTSING THE 1947 U.B.0 FEE SCHEDULC)
TOTAL JOB VALUATION $ 2702.00 OCCUPANCX_ TYPE _
Pentrit Fee
Plan Iieview
Fire, Surcherge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ �'� ,�} � See Back Page for Pee Schedule
$ b5% of Bnilding Permit Fes
$ ,� .001 times the totai job valuation
$ 1, 7� .t?�5 x Permit Valuation Minimum $.50
$ � -�j , � $5.00 (State Licensed Residential Contractors)
$ $1550 per SAC Unit (PEans to MWCC for determination}
$ ft+68= ftx$21=5
$ �450 Conservation Plan Review
$ Fee Determined by Enginecring
$ Agreement necessary ( ) Non Necessary ( )
$�i �l. N� Make checks navable to: City of Fridley Attac
TH(S IS AN APPLICATION FOR A PERMCf-NOT VAL1D UNTIL PROCESSED
I hereby apply for a building pennit and I aclrnowledge that the information above is c�mplete and accurate; that the work wiil be in
conformance with the ordinances and codes f the City of Fridley and ovith the Minnesota Construction Codes; thet I understand this is not a
permit but only en applica�on for a d work is not to start without a pemut; that the work will be in accordence with the approved
plan in the case of al�,work ' req view and approval of plans.
SICiNATURE OF APPLICA11Ci' pRINT NpMg Em i ly Berna rd DATE��� ��