AF - 47048City of Fridley, Mi�.,
BUILDING PERMIT No 4 8 s s�� �
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Date: ._.._.._...�_'.""_._.�.._"�'_°. _� _..._._._....._...._
; � �
,: � '� : � /
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Owner: ... .. . `° Builder
�... _ _.._P._.... . _ • �
. _ _.._....__.�._.._.._.._ ._._..___.
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..
Adc�ress _. __ � � Address _....____. .._ ._...._ ;. _ ,�._._._.......__.._._.._.._..._.
}����" ' LO TION BUI4DING
No. _.� �� .. ��' :���
�._. . .. Street __. ___.... .. ' ` .-- . .., .1......,���..._ Part o Lot ....._....____._.._._.___...._.....__ . _.._._..
..� �
Lot ; d.�_."" �".'.�.�,...... Block ..-----...... ..._.-------------- Addition or Sub-Division _ .... . ._ _ __ _.__ _....� .__
..ap
Corner Lot ...---.----------•--------•-- Inside Lot ._._�"..!'.� ................ Setback _--. ".� ....._•----._._. Sideyard ....��_.___..._.-•-------.._...._-----._.__._
Sewer IIevation
Foundation IIevat3on
DESCRIPTION OF BUILDING
To Used as: �
� �d �. �9, , , y / ,y�,
----- ----- ---. Front �!C_/._--- Depth .. �,p�-. .....5� .. Height ....�°.�•�'.._.. Sq. Ft.���.y�� Cu. F� ����
'� pE
..----�--�•-�--------��--�--.._.._..._.---�-----... Front ._---....._...._.. Depth ....._ ............._ Height�_--•-�-•--.._........� Sq. F� .....-----------..._.. Cu. F't. _..------........_..
Type of Construction ��.. ... Est. Co�� ,r�,,� �+
,�,r��..�i.�.J� --,/`� � .;,�- - �i�' `..".'��o be Completed ....._.......___.._..._._.----._.._--
In conaidera.tion of the issuance to me of a permit to construct the building described above, I agree to do
the proposed waa�k in accordance with the description above set forth and in compliance with all provisions of
ordinances of the dty of Fridley.
Q___._.____ �_
In consideration of the payment of a fee of $.�.�._.._...__._...., permit is herebY granted to...-----.__....---...—..._....•--_.._...___
_._ to conshvct the building or addition as described above. This permit fs granted upon
the express condition that the person to whom it is granted and his agenta, employees and worl�ien, in all work
done in, around and upon said building, or any gart thereof, shall conforin in all respecta to the ordinances of
Fridley, Minnesota regarding location, construct3on, alteration; maintenance, repair and moving of buildings
within the dty limits and this permit may be revoked at any time upon violation.of�ny of the provisions oP:said
ordinances. s�'"'3 �.r7 .d
Building Inspector
NOTICE:
This permh does nof eover the eanslruetioe, n��een.no� for wiring, plumbiag, gas heaKng, sewer or waler. Be sure to aee
fhe Buildine Inspeefor for separa}e permits fo� fhese hems. • .- � ��u�j��
^ � 4 THIS PEFj1�T DOES i�OT AUT LA;�-
r- ` ION OF A, .� Pi�{�'A� TE LAND COVENANTS A►ND
t ,,�� ti. � - .
BUILDING RESTRICTIONS. �..__.�_:-..
Owners N
Address
No.
APPLTCATTAN FOR BIIILDTNG P�T
CITY OF FRTDLEY, MINNESOTA ��``�
� LOCATiON OF BIIILDING
of Lot
%t - Blor.k . �ddition or Sub.Div. �'� ��.���
_.,..,
_._`
Corner Lot� s3de Lot �3et Back �� �� Side-Yard 4_.
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Cert3ficate of Sv.rvey of Lot and propos� building
location.
DESGRIPTION OF BIIILDTAIG
To be used ass
/
" F�oat Depth Height. � .., _
u"�q. Ft.! O.�-fw Cu. Ft. ����
Front Aepth Hei;�ht
. � �--.
Sq. Ft. Cu. Ft, Y
� ��
Tgpe of Congt.ruction ��S�e fr� .�� timated Cost�.,,,�,� �.,�
To be completed , _,____.__ �� �,. -
The undersigned hereby makes application for a permit for the work herein spedified,
agreei�lg to do all rrork i.n striot accordance w3th the City Ord3nances and ruling of
the Depart�ent of Buildings, and hereby declares that all t�e facts and repreaent,s-
tions stated in this appl3cat3on are true and correct.
DATE ,� �a s /�SIGNAT�iE � � ����� _.._.._-
(A Schedule of Fee costa c�n be found on the Reverse Side.)
r"`,
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�`'�
HIIILDING PERMIT �'EE SCFiIDU ''
S�ction 2. The Inspe�tor oY Buildinga shall, before issu.i.ng ang perm�tt
for the erection of ang build.ing or structure, or for any addition to
an� exiat3-ng buildi.ng or structure, or for any alterations or repaira
to any► exiating building or atructure, upon application therefor, require
the payment by the applicant for such permit of fees to the�amount here3n
beiow aet forth and. in the manner herein proeided to-wit:
2.1. For any such permit for the erection of any fixe-proof building,.othar
thau a garage, warehouse, factory or grain elevator, or for the erection of
any firegroof addition, for similar occupa.ncy, to any existing building
sha.�]. be at the r�,te of .�7..40 for each one thausand cubic feet, or fraction
thereof, in such cubic�7. contents.
2.2. For a,ny auch permit for the erection of e.ny fireproof garage� ware-
hause, factory or gra3n e].evator; or for the erection of any fireproof.
addition for similar occupency, to a.ny exist3n� building shall 1� s.t the
ra.te oi �1.25 for each one thousand cubic feet, classified as "fireproof" ,
by Section 502 of the Minnea.polis Building Code.
QH IISES
2.3. For any auch permit for the esection of any non-fireproof buii.ding
qther_th.en �z garage, warehouse, f�ctory or grain elev�.tor, or sny non-
fireproof add3tion, for simi7:ar occupan�y, to any existing build3ng. -�
Permit �]..� for each one thousand cubic feet.
GARACE3
2.4. For any such permit for the erection o£ any non-fireproof garage,
warehouse, factory or grain elevatar, or for the erect�.on of any noa- �
fireproof addition, for similax occupanc�, to arry existing building
for each such building or addition. Ninety Centa for each one tho�d
cubic feet or f"raction thereof, in tha cubical contents thereof w3th a
m3animum of �4.00. �
For the purpose of computi.ng fees for building permita the cubical contents
of any building or addit3on to a uniform. height throughout by mult3plyiag
the gronnd area coqered from a point six.(6) inches below the floor line of
the basement or cellar to the �,verage height of the upper aurface 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 shal.l be
at the r�.te of �3.00 for es.ch Five Hundred Do11a�,s (�500.00)� or fraction
thereof in the coat of all proposed work.
2.6. In no case
Section-2 be less
;r• "'� . ?
shall the fee charged for any pex7mi.t sa set forth in
than �4.OQ.
�
�
,,. -
F� . .- .
HARVEY A. GARTWRIGHT C��GST & O�ON
ANOKA COUNTY BURVEYS
NENNEPIN COUNTY SURVEYS LA ND S UR VE YORS
MINNEAPOLIB SURVEYB
8410 PALM STREET N. W. RE61�T6RiD UNOBR LAW6 OF BTAT6 OF MINNE80TA
� SUNSET 4•7855 LICENBlD BY ORDINANG[ OF CITT OF MINNEAPOLIB
01NNER
326 PLYMOUTH BUILDING FEOERAL 8-8721
INDUSTRIAL - JUDICIAL HENNEPIN AT SIXTH • MINNEAPOLIS 3. MINNESOTA
BUSINESS - TOP06RAPHICAL $,�rbepor'g 4�ertiftcatc
CITY LOTS - PLATTING
Al lT'llliaims „
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COMBINING THE RECORDS OF
J. E. HILL, Civi� ENGINEER
EBTABLIBMED 1BY6
C. F. SANDHOFF
CIVIL ENOINEER
ESTABLISHED 1Y08
JAMES NELSON
SURV6YOR
ESTABLIBMED 102Z
METROPOLITAN LAND
SURVHYORS. ESTABLISMED 1991
Invoice 21290
?fl2/27
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I her�by certify that th is is � true and correct reprQSentation oi a surv�y of
the b.oundaries oi:
Zots 7, 8 and 9� �lock Q, RivervieUr Heights
As survey�d by me �this 2�th day o�' �:pri1, 1960. �
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City of Fridley, Minn.
BUILDING PERMIT
� .
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N° 6925
Date: � " f-.�-�–'"' �.—,�
Q �
Owner: � . ;.�� . ��/_",t�� gu3lder �
Address Address
LO TION F BUILDING
NO. .�9�� StcEet ._... � � Part t
Lot � _ Block �— Addition or Sub- on �� � s
Coraer Lot _ Ina3de Lot ��back Sideyard �"�` --
Sewer IIevat4on — � Fo tion IIevation
DESCRIPTION OP BUILDING
T �
F'ront � DeP'th �°�� Height � 54• F� ;���"- Cu. Ft�� �
Front Depth ITeight Sq. Ft. Cu. F''t
Type of Constructfon �_�. Fas�_C'o�i/��.�'�J��°_ To be Completed
In consideratton of the issuance to me of a perm4t to construct the bwllding descrilxd above, I agree to do
the proposed work in acc�rflance w3th the descrlption above set forth and in compliance wi all provisions of
ordinances of the dty oP FrYdley. �_ ������
� � f� �
Ea co�sideration oP the payment of a fee oP �'� ._� permit 9s hereby granted to
to construct the buflding or addition as descrlbed above. 'This �rmit fs granted uPon
the expre� conaition thet the n to whom ft fs granted aad his agenta, emPloyees and worl�aen, in all work
dane in, around end u�n sai building, or anypart thereof, st�all conform in all reapects to the or�linanc�s of
Frldley� Minnesota reg lacation, conatruct�on, alteration� maintenance� repair and mov3ug of buildinga
within the dty ]fmfts aad� permit may be revoked at any tiaae upon violat3on of any of the Prov9sions of seid
orainaaces. �, �^✓� �–i
Bu9lding' Iaspector
Nonc�
'ihb permtf does net eavsr tia coestruedoe, tmhWlton /er �Gie6. P�+m9. On 6udne, swvu er wusr. B� ans to a�
tla &dldia0 les�etoe to� aparaf+ p�rmha hr thws h�ms.
sue�ecr PE O.
City of Fridley 2� 5 9 3
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
; � RECEI O.
i V �������,
COMMUNITY DEVE�OPMENT DIV.
r � � � PROTECTIVE INSPECTION SEC. /
i �
1 . , �
, � /�"� � CITY HALL FRIDLEV SB432 NUMBER REV DATE PAGE OF APPROVEO 8Y
�""'� � �'' 612-571-3450 910-F15 10/14/97 / /
JOB ADDRESS 633 IRONTON STREET NE
1 LEGAL LOT NO. BLOCK TRACT OR AODITION SEE ATTACFIED
DESCR. ]�$� 9 Q Riverview Heights SHEET
2 PROPERTY OWNER MAIL ADDRES$ 21P PMONE
Chris Miller 633 Ironton Street NE 784-2322
3 CONTRACTOR MAIL ADDFESS ZIP PHONE LICENSE NO.
Panelcraft of MN 3118 Snelling Ave S, Mpls., �V 55406 721-6628 2179
4 ARCHITECT OR OESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE IICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION O ALTERATION C� REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOFK
Reside House & trim
9 CHANGE OF USE FROM TO
STIPULATIONS
Install building wrap and have inspection of same unless ma.nufacturer's
specifications state it is not required.
TYPE OF CONST. OCCUPANCY dROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIFED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV TNAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOfiK WILL BE COM,PLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. TNE GRANTING OF A PERMIT �3�872 �1.94'
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEfiMIT FEE SAC CMARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �57. LS Fire SC �3. S%
PLAN CHECK FEE TOTAL FEE
License SC $5.00 $98.06
S�GNAIUREOfCON'RAC70AOAAUTNORIZEDAGENT ioATEi , WHEN PROPERLY IDATED THIS IS YOUR PERMIT
� ( V
T-S�GNATUREOFpWNEAi�FOWNERBUIIDERi �DATE� BIOG NSP � �i`TE
. � s
.NCW
ADDN
ALTCR
Z.
Cc?nstruction Aciclress `.
Legdl D�;scri�tion: --u--
Owner Name & Address:
Contrac;tor
,
Address:
LIVING ARI'sh:
GARAG� ARCA:
D�CK AREA:
OTHER:
�.�n
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLCX�S R-I AND R-2
Buildinb Permit APplication
s
Lft�ective 1 / 1 /)4
���i�l
;� �
°��kJ� Tel. # �iSy- O� ��o�
� MN LIC�NSC ��r( 1 _
� Y �\��� , I 1 .e�� C Tel. #��-CD CP ��(
Attach to this application, a Certificate of Survey of the
lot, with the proposed consiruction drdwn on it to scale.
DESCRIP'TIG1N OF IMPRC�VEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
sy. rt.
Sy. Ft.-
Sq. Ft.
Corner Lot ( � Inside Lot ( � Ft. Yd Setback Side Yard Setbacks
cao
Type of Construction: �C%� nc� ��'��'K� Estimated Cost: $__SZ�°2 .
Approx. Compledon Date: �
(Cost on Back}
Drivewa Curb Cut Width Needed: rt. + G Ft = Ft x$ _�
U�AT�:�" �'1 � APPLICANT: � p 1109�/l� Tel. #%aa DCD�� __.
�-�"' " "
Permit Fee (���. ��^ $
�ire Surchar�e � , � $ —��
State Surcharge � %y $
�SAC Charge $
License Surchar�°��$
Driveway Escrow � $
Erosion Control $
Park Fee �
Sewer Main Charbe $_
('ITY US� QNLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.SO/$1,000 Valuation
$800 per SAC Unit
$5.00 (State Licensed Residential Cnntractors)
Alt, "A" or Ait. "B" Above
$450.00 Conservation Plan Review
Fee Determineci by Engineering
Agreement Nece.ssary (] Not Necessary ( 1
TOTAL �n • �� - -
�
. __--___ ,
_.___ _
_: _. � ���
STIPULATIONS' '' � �-T`� �' ��
�
��. � � ��.� � � j D ` � �� - -
�
,
� �. -
B�.ilding BUILDING ---
It�spe�tions ����ENTIAL A►PPLIC�TIUl�
763-�7x-3b►U4 CITY �F FRI�LEY
DA'1�� .�!/•.•.d �'. .... YO[)Ic L MAIL AuuRH:SS
srrE ar,�irc�ss� .. I'^era� r'1 �- /1� � . _ .. _ _'". .
TtI6 APPLIi;:ANT' 1\: ❑ QWNER ]�]CL}N'fliAf°fOR
PAOgEk'1"it GwNERI
TEATAtYT
co�a�roR
SL1131V[IT A C�PY OF
YDUR �'TATE LICENSE
@IITH APPLICATION
PRUPERTY TYPE
'TYPE
TYPE OP'
PIIONG:. _ � (p�S _
NAh1L�: / �2
STA'['� Li(:�1�IS� ��
r1UDRG55: .. .�!'
Z �
m
rt�Urrs loS/-Yo.s o,c�
. INGLE F.AMILYlNEW C�NSfRTI(..,'fN
C] TWO TAMILYINHVr �UNS�rR��G°i'ICJN
o eas�rrr r•nv�s��i ❑ Rsac)r�
❑ DEI.`K O 3lDING
�
DESCRI�E WORK tiEING DC�NE: I�m �J L�1 �e-,.�.1 ,
,..
SIZE OF 1MPROV�MENT LL�I►1C;7'H
or s�ua�s
GARAG�S
PRaPOSED Si�:
}'F1UF'USED HEICii1T:
. r r�
Q Yut,Yl
[7 Alumim�m
q Othcr
WINIXyVYS
IN EKI3TLY0 OP�NIIdt7S �c; �No
bR E(�t N�W UPEAf1NG3-DESGRII3E S1ZE ()F
4PENWG �I3ANClES &
ALL FE�S AR� DAS� UN
aaa�.�a.
Permit f�ee
Plan Ree�bew
Fir� Surchar�e
Surdisrge
License Surchar�e
SAC Cherge
Gurb L'nt Egcrpw
Erosion Cantral
�arl: Fe�
S�w•c+t Mau► Charge
Total Due
❑ HOL)$E & (iARAGE
I� ATTAGHLD (iAftAGE
❑ DF.TA[.'HEi) GAItA(3E
❑SoPfit
I� Trim
❑ Fascia
LOCA'tIt�Ai OF WINUI)�VS
►`i�
(USING
TI�IN $
�'�'08�`7
�
P�rnnit No.:
Receiveci .Hy:
1]ate Rec'd: �
a ,,..�1
,. �i � c�, f�c.1 ..,. ._. S���A'I'h!!urGiF SS'��S �
�XP DATE _s� .31 � `] �--. . ....
CITY � ?A^� _iTATE/�1� ���
� s/- o� /7�s�.. .�
�
❑ DRAR�! Til.i�
�l?�HF_,R�_ _
,,c,iW`wrr.
,5�� S: Z�.
HEIGHT___ Sq. b"t.
F}ASENIEYJT REMODGLIPICS SUA�+j!'i':
1. �xistiag Floor Plan
2. Prc�pnsed t�aor plan
3. List oPstrual+wt memtnrs to 6e t�sed
FORNL"•W CONSTRU[:TI(1N INCLUDWCr DGCKS,
AL7iUI'I'1('1NS. & PORCH�S S[f$T4IT;
1. Sito Plan/Surv�y ehaweng thc cxistmg strucwr�
and R�F� P�Jca.
2. Twi� ecl* af wnstrucdon plans
3. Eaargy Galculations
:R OC WINUO WS % d �
LUDINC THE COST OF LABQR AND MATERIALS:
U.B.0 F�',E 5C1�tEDULE)
TY PE
� See Back P�ge; fpr Fee Sch�ule
$ 65% pf Buildiu� PePmit Fc��
� .001 times th� tatal job v�lut�icm
� .0005 x l��rmit Valuu�tttion Minimum $.50
� $SAO (Statc Gic�ns�ed Residentiai Contrqotors)
� $155Q per SAC' Unit (PI$ns to MWCC for determination)
� _ i1+61�° Sx$21 -$
� �450 Conservatian Plan Roview
� Fee Determin�d by �n�ineering
� Agreemcnt necessary ( ) Non Nacessa�y { )
� __ Make cliec:ics u�.yable to: Citv oY F'ridler Attac
'THTS IS AN APPLI4ATIt]N f1�R A pL.liMl'i'-N(aT VALti� UNTIL PRUCGS��t?
I u�reby apply for a b�ildln� �rmit and I aclmowledge that ehe infarrnation above is complc,�te and accurate; thai the wc�lc w4(1 be in
conformance witi� the ardfnence� ���ies �f the City of Fridley �d wieh ehe M'mnesota Construction Codes; that I understand this ia not a
pennit but only an application for a permit and work is not to sta,►�t w[ttiout a pormii; ihat the wark wi7l Ix in accordanee with the ,a�proved
p9an in the c;�s� ot'�II work w' requires teview �nd appruvxl t�f plens.
SDCfi1A7'pii� UF :�YLICAN7' ^ PR1TtT NAM� ��r� Q �I � �1 ��'+ DATf: � � � � ,_,_,_
.,.;�_
bd Wt�c'.z : Z Z g�Ei� 9� °�ant �� ti T L�9z :'ON :�'ti� � a[ P t-�� ,t � h� t�: W�
Building BUILDING re�it Ivo.: � 510
Inspections RESIDENTIAL APPLICATION Rec�ived By:
763-572-3604 CITY OF FRIDLEY n��'b�QV ����� �
763-502-4977 FAX ��c�v�,_,�9
DATE � I l�I D 1 YOUR E-MAIL ADDRESS
S��D�ss 33 r n+� St- N-�
THI.S APPLICANT IS: ❑ OWNER ONTRACTOR
PROPERTY OWNER/ Nn�: r i 5 �ro I M� I�e-r
TENANT nnnitESS: Si �t a.d e SS CrrY F+�i d-�eu sTn� MN ztP 5'��S'Z.
$u 'Z3 ?- � —�
PHONE: �I lQ 3 � � I �
conrra�►c�roR N,�,,,¢:-nne W� h� S+a�r� �-t�-�,e �.�,-►�l�rv�,r� �-�
SUBMIT A COPY OF STATE LICENSE # o�D �� I��%— EXP DATE _ �' I �
YOUR STATE LICENSE q �+ T` o `��
AND CERTIFTCATE OF ADDRESS:��-1 �_—�7 �1 vi(' � JJ� . �P . 2.� t% CITY f �1� �/Vl b 1/� V� STATE�ZIP `7 5`f �F I
INSURANCE P ONE �I I� 3•�� 10 ' S°i � D FAX iD � Z'�2 � s �
PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCITOIV SIZE
0 TWO FAMII.Y/NEW CONSTRUCTION STORIES
PERMIT TYPE � �DI1'ION ❑ GARAGE/SHED WS
� BASIIVIENT FINISH � ROOF ❑ DRAIN TII,E
❑ DECK O SIDING ❑ �T�
O SWII�IlVIIIVG POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDTPION
❑ MAINTENANCFJREPAIR ❑ REMODELING
nESCx�E woiuc sEn�rc no�:1Z�-�o t a c� l � d o u b I� �n tc�+ a w i h i� Str �l-5
SIZE OF IlVIPROVEnRII�TT �rTTH �TH �C'� S �
ROOFING 0 HOUSE ONLY BASEIVIENT REMODELING SUBArIIT:
NUMBER OF SQUARES � HOUSE & GARAGE � ���g ��r p��
GARAGES 0 ATTACHID GARAGE 2. Proposed floor plan
PROPOSED S1ZE: ❑ DEI'ACFIID GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDIATG ADDITiONS. 8c PORCHES SUBNIIT:
❑ Vuryl ��� 1. Site Plao/Su�vey showing the existing structures
❑ Aluminum O Trim �►d P�Po� ProJ�
❑ Other ❑ F�� 2. Two sets of construction plans
R'INDOWS 3. Energy Calculations
IN EXISTING OPENINGS es ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPINING CHANGES &
TYPE OF WINDOW TO BE INSTALLID � Ub,Ci NUMBER OF WINDOWS �
ALL FEES ARE BASED ON VALUA N, INCLUDING THE COST OF LABOR AND MATERL�LS:
'OTAL JOB VALU
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Dne
NG THE 1997 U.B.0 FEE SCHEDULE)
� -- [X'f'ITP,
$
$
$
$
$
$
$
$
$ . �, a_ � _ �
See Back Page for Fee Schedule
65% of Building Permit F�
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2000 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 ch�ks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in
conforn►ance with the ordinances and codes of the City of Fridley and with the Minnesota Constrvction Codes; that I understand this is not a
pemut but only an application for a permit and work is not to start without a pernrit on site; that the work will be in accordance with the
approved plan in the case of all war/k w'c requires review and approval of plans. 't ���
SIGNATURE OF APPLICANT / � Y PRINT NAME MI ��IPi IIUL�R�Pi I DATE I 1
NOTE: SEPARATE PERNIITS ARE REQUIItED FOR PLUMBING, ELEG°fRICAL AND MECHANICAL