AF - 47153Village , of Fridley, Minn. ,
BUILDING PERMIT
t��'� .i- � �_%� •;J� • '�""��'P � �" .
Date: _. .:.. . ...�i .......... ......
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Owner �. +,,,�. . �f?. .+�`.�: •s� . .
Address .�.�. � � . �
. ,y.. f . . . .-. . . � . . . .
11T° 1994
Builder ......... ....... ..... ........ ...
Address................... ........................
LO ATIOI�I OF BUILDING
`�� "�� �� � =�,�,_� .. .. .. .. .. . Part of Lot . .. ... .. .. . .. . . . . .. . . .. .. .
I
1Vo. ,�. r"'�. . .. ., . Street . .. ...a?�':'�`�' ...
F�
Lot .............. Block .....:............ Additioa or Sub-Division ............... ...... .............
Corner Lot . . . . . . . . Inside Lot . . . . . . Setback . . . . . . . . . . . Sideyard '���r�': �:"'�� � ;":�: . , , , . , , , , , -
� DESCRIPTION OF BUILDING
To be Used as:
, �� . �: �: . . . . . . . Front ,,%I: . Depth ,�s,.� . . . Height �'�. � . . . . Sq. Ft. . . . . Cu. Ft. . . . . .
Y�
..................... Front ........ Depth .. ... Height ........ Sq. Ft. ..... Cu. Ft ........
Type of Construction ��--;a'�:�:°:�w�;�°: Est. Cost.��.,� .�.d � �. . . . . . To be Completed,.-: �'�� t���:��.� . �� � .
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In consider�.tion 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 oi
ordinances of the vilIage of Fridley.
.1:.i1.-��-r� �!�!!.. �. .���L? ..-....
Tn consideration of the payinent of a fee of $. .� -;�:'; ..., permit is hereby granted to -�r-r�i�� "� .�,: :./.....
�`'��� ��.`:� '� '�. ...... to construct the building or addition as described above. This permit is' granted upon
the exgress con�tion that the person to whom it is granted and his agents, employees and worlanen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinanc�es af
Fridley, Minnesota. regarding location, construction, alteration, maintena.nce, repair and moving of buildings with-
in tfie village ].imits and this permit may be revoked ai any time upon violation of any of the provisions of sa.id
ordinances.
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NOTICE:
This permit does not cover the aonstruction, installation or alteration #or wirtng, plumb(ng, gas heating,
sewe� o� water. Be sure to see�e Building Inspecto� for separate Aermits fo�fiese tEems.
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City of Fridley, Mirm:.
BUIT.DING PERIV�IT
N° � 580'7�
Date: �."� � � �" � �
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Owner: �� � � —... Builder -- —
Adciress � r ..._. Address
�- LO TION OF LDI(VG'
No. .�-���Street �"" -- -��' ���Part o t •
f.�
Lot _�r,L.Z_ Slock �!-�� Adc3ition or Sub-Division .� '��-�-�--=-�-� " .
Corner Lot._ Inaide Lot �� Setback `�� Sideyard� _ . �
Sewer IIevation — — Foundation IIevation
DESCRIPTION OF BUILDING
To v as: � �,p
�" Front ��� Depth .�_ Height +i`"�'� Sq. Ft � Cu. Ft .+"'�
Fro Depth �Height �_ Sq. Ft Cu. Ft
Type of Constructiad;�"�,'?��..i��- Est Cost ��� ��To be Completed
In considerai3on of the 3ssuance to me of a permit to construct the building descrlbed above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions oP
ordinanc�es of the dty of F'ridley.
�
In consideration of,the payment of a fee of $� "�~ , permit is hereby granted to
to construct the building or addition as described above. Thispe rmit is granted upan
e 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 building, or any part thereof, sha11 coffiorrn in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintena.nce� repair and moving of buildings
� within the city ]imits and thia permit may be revoked at any time upon violatioxk�y of the provisions of said
ordinaacea �4 �`'
Inspector
NOTIC�
Thb penntt dees ao� eove� t6s eoaitruetion, Uutallatlon fe� wiriae, plmnb6►g, ges heaHng, sswer or water. Be sura fo �
fhs Buildie0 Inspeetor for ssparata permits for these (tems.
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APPLICATIOP FOR BUILDING FERI�T
CITY OF „FRIDLEY, MQiNESOTA
�:.. Own.er' a Neme � � Buildea r
�iddress ,_�,Ad�S
No. � � �� Street
,
dF BUILDING
.Part of Lot
Lot Block Addition or Subdivisioa
.� / � .� i
Corner Lot�Inside Lot � Set6ack' ', Side-Yard �
�EWER ELEVATION �FOUNAATION EL�VATTON _
Applicant attach to this iorm Z'wo Certificatea of Survey of Lot and proposed
building location drawn on thes� Certificates.
DESCRIPTION OF BUILDING
To be used as; �
. %� � `/ � l�/
C�`" Front �_���Depth__��Height %
Sq. Ft. �� �� Cu. Ft. ��`'��
� -�Fronf " Depth Height -
$q. Ft. Cu. Ft. �_
. � l�E��� �_-
Type of Constxuc�ion Estimated Coa
To be Completed� ' � ___ '
�he undersigned hereby makea application for a p2�rmit for the work herein �
specified, agre�ing to do�ali work in�strict accordance with the City of
Fridley Ordinances and ruliags of the Department of Buildings, and hereby
declares that all the faets and representations atated in this application
�re true and �correct: • �
DATE ,.,� �' � �"' (� � S�cNATURE . �� � e
(Schedule of Fee Coats can be found on the Reverae Side).:
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BU7Z�DTATG PER1NaT FBE SCHEDULE
Section 2. The InspecCor of Buildinga shall, befor� issuing any permit for
the erect3oa of any buildiug or structure, or fos any ad'dition to anq exise-
ing building or strucCure, or for any alteratiQn�, or repairs to anq esisting
building o� s�ructure, upoti application therefor, require the payment by the
appl3canC for such permit of feea to the amount herein below set forth and
in the manner herein provided to-wit:
2.1. For any such parmit for the erec�t-fAn of any fire-proof building, other
rhen a garage� warehouse, factory or grain elevator, or for the erectioa of
aay fire-proof �ddiiion, for simflar occupaacy,. to any eatisting building
shall b,e at the rate of-$Z.�+O`for each one thausand cubic feet, or fraction
thereof, in such cubical contenta. .
2.2, For any auch permit for Che erectioa of any fire-proof garage, warehouse,
f�ctory or grain elevator, or for t�ie erectian of any fire-proof addition,
for similar occu�ancy, to any existing building sha7,1 be aC the rate of $1.25
for each one thousand cubic feet, clasaified as °ofireproof°1 by Section 502 of
the A�i.nneapolie Building Gode.
HOUS�S
2.3. For any such permit for the erection of aay noa-fireproof building other
than a garage, warel�ause, factory or grain elevator, or aay aoa-fireproof
-�azYcti`�3�, or s i�ar occupancy, "to -any ex�et ng u Id3ag - permi.t �1.00 for
each one thousand cubic feet.
GARAGES
2.4. For any such permit for the erection of any aon-fireproof garage,
warehouse, factory or graia elevator, or for the erection of any non-fireproof
addition, for similar occupancy, to any existing build3ng or for each such
building or addition - niAe�y centa ($0.90) for each oae thouaand cubic feet
or fraction thereof, ia the cubical conteats thereof with a min3mum of $4.00.
For the purpose of c�nputing fees for bui�ding permits, the cubical coatents
of any building o�t additioa to a uniform height throughout by multiplying the
ground area covered fram a ppiat aig (6) inches 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 o£ a pitched roof.
2.5. For repairs or alterationa to an existing etructure, the fee ahall be
at the rate of $3.00 per each Five Hundred Dollara ($500.00) or fraction
thereof in Ehe cost of all propoaed work.
2.6. � no ca�se aha11 the fee charged for any permit ae aet forth ia
Sectioa 2 be less th�n $4.00. �
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City of Fridley, Minn_
BUILDING PERMIT
Da�: OCTOBER 5, 1965
p�; FRANCIS MCCAR�Y
�� RAY SWENSON
�e,d� 5735 �'ackson St. N. E. A�
Fridley 21, Minnesota
No 5735
� �4
Coraer Lot _
Sewer IIevation
3�fi� S�
N° 8508
LOCATION OF BUILDING
Str�et Jacks on S t. ft. E. p� oE Lot
, Block 5 Ad�ition or Sub-Divisfan Donnays Lakeview Manor
Inaide Lot � Setback � Sideyard
Fo�mdatioa IIevation
DESCRIPTION OF BUILDING
To be Used as:
Frnnt �pth Height Sq. F't. Cu. Ft
Front Depth I�eight Sq. Ft Cu. Fk
Type of Constructton �, �_ 1 5 00 . 00 To be Completed
REPAtRS AFTER FIRE
In c�slderation oP the fsauaace to me of a permit to canatruct the building descrlbed above I agree to do
the proposed work ffi accor3ance with the d�ecription above set Porth aad 9a compliance with af 1 provisfons of
�dinances of the dty oP Fridley.
� �
In cxm�deratian oP the payment of a fee oP � 9• 00 ^ � permit is hereby granted to �'Y SWENSON
to conatruct the builafag or addition ea described above. This �rmit fs granted upon
the expre� condition that thepe�on to whom it 9e graated and hfs agente, employees and worlQnen, ffi all work
done fn, around and upon sa4d building, or enypart thereof, ahall conform 4a all respects to the ordinaac�s oE
Fr1�IIey� M9nnesota g locatson� construct4on, alteration, maiatenaace, repafr aad moving oE buildiugs
wlo��� dty ]imfts� and�thfa permit may be revoked st e�Y tlnae upon violation of any► of the P�vieions oP eafd
AT T•RN' G. JENSEN 8��8 �
NOflC�
� p�rneh dea eee ao�ar tla eee�feuaH�, �a�loe �or vr6�no, plum6tnq, oa h�tliea, swnr or wab�. B� an to �
du Boildie8 In�tee �e� pp�►ah pum6s ter fh�a B�mf.
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APP'LICATION FOR BUILDING PERMIT
CITY OF FRIIiLEY, M[NNESOTA
O�
OWNER'S NAME � BUILDER .
ADDRESS � � � � ADDRESS ��/� �����-�-� ����� •
LOCATION OF BUILDING
N0. STREET PART OF LOT
LOT BLOCR ADDI1`ION OR StJBDIVISION
CORNER LOT INSIDE LOT SETBACK SIDE YARD
SEWER ELEVATION FODNDATiOft ELEVATION
Applicant attach to this form Two Certificates of Survey of La�t �nd �iroposed
building locatioa drawn on these Certificatea.
�'o be used as ;
DESCRIPTIOP OF BIIILDING
Front Depth Height
Sq. Ft. Cu. Ft.
Front Dept T Seight
Sq. Ft. Cu. Ft.
��
Tqpe of Construction � Eetimated Cost_ /,����
To be completed
v � �s(o�'�iil'
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and ruliags of the Department of Buildings, and hereby
declares tha.t all the facts and representations stated in this applicat3.on
are true and correct. �
DATE /� � � � SIGNATURE ` �sf�� ��
p •/� �� e
(Schedule of Fee Costs can be found on the Reverse Side). .
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BII�DING PERMIT FEE SCIiEDDLE
SECT_ ION 2. The Inspector of Bui�dings shall, before iseuiag aay permit for
the erection of any building or structure, or for any addition to any euisting
building or structure, or for any alteratione or repairs to any existing
building or structure, upon application therefore, require the payment by the
applicant for such.permit of fees to the amount herein below �et forth and in
the manner herein provided to�wit;
2.1. For aaq such permit for the erection of any fire•proof building,
othei th n a garage, warehouse, factory or grain elevator, or for the erection
of any fire-proof addition, for similar,occupancy, to any eaisting buildiug,
sha11 ba at the rate of $1,40_for each one �housand cubic feeE, or fraction
thereof, in such cubical contents. ,.
2.2 For any such permit for the erect�on of any fire-proof garage,,
warehouse, factory or grain elevator, or for the.erection of any fire•proof
addition, for similar occupancy, to any ezisting building shall be at the
raee of $1.,25 ior each one thousand cubic feet, clasaified as�"fireproof"
by Sectioa 5.02 of the Minneapoli� Buildiag Code.
flOUSES ,,,
2.3. For.any such permit-�for.Che �erection of any aon-fireproof
building, other than a garage, warehousa, factos�q or �rain elevator,.or -
any non-fireproof addition, for similar occupancy, to any e�isting building -
permit $1.00 for each one thousand cubic feet,�� "
GARAGES � ..
-_ ,.
2.4. For� any auch permit for tha ere�tion o�'any non-fireproof garage,
warehouse, factory or gr.a�tn elevator, or for.the erection of any non-fire-proof
addition, for similar occupancy, to any egieting buildiag or for each such
building or add3tion - ninety centa ($0.90) for each oae thous.and cubic feet
or fract�on thereof, 3n the cubical content� •tl�ereof with the minimum of $4.00.
For the purpose of computing feea for building per�nits, the cubical contents
of any building or additioa to a uniform height throughout by multiplying the
ground ares covered from a point s9.x (6) inches beYow the`floor line of ��e
basement or cellar to the. average h�ight of the upper surface or to the average
heighe of the roo� surface of the main gable of•a pitched roof. .
2.5. For repairs or alteratioas to an exisring st?��cr_t�.re, the fee shall
be at the rate of $3.00 per each Five Huadred Dollara ($5�ai.��7j or fraction
thereof in the cost of all�propoaed work. '
2_.6. In no case shall the fee charged.for any permit as aet forth in
Section 2 be less than $4.00.-
STORM REPAIR DAMAGE FFFS; . .
Residential; Est:!:n..��ed :Co�t o� work up to N5�0.00 -$S.�JO �
Esci�, �ed Cos�t of wo�k ovzr y'i;�;+��J -$;.C,�O. � .
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CommerciaZ; Estim�ted�$t -.�rf �ah�k up t��4:e��'=7=ty0 _ �ip,,ss�
� Estiaiated st of wuriz ouer $5��1.00 -$Z0. , G�*� �-�
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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r � � PROTECTIVE INSPECTION SEC.
1 . �
i_.•- ��'��,.� CITY HALL FRIDLEY $$432 NUMBER NEV DATE PAGE OF
L �� 612-571-34b0 910-F15 8/14/97 � �
JOB ADORESS 5735 Jackson Street NE
t IEGAL LOT NO. BLQCK TRACT Ofi ADDITION
DESCR. 14 5 Donnay's Lakeview Ma.nor
2 PROPERTY OWNER MAIL ADORESS
Rurt Luther 5735 Jackson Street NE
3 CONTRACTOR MAILADDRESS
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAIL ADDRESS
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW
ZIP
ZIP
ZIP
,�153b8
�,
RECEIPT NO.
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APPROVED BV
SEE ATTACNED
SHEET
PHONE
572-1125
PMONE LICENSE NO.
PFIONE LtCENSE NO.
PHONE LICENSE NO
O ADOITION ❑ ALTERATION C� REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (18 Sq) Tear—off
9 CHANOE pF USE FROM
STIPULATIONS
TO
Underlayment must comply with the State Building Code.
SEPARATE PERMITS AR� REOUIRED FOR ELECTRICAL. PLUMBINO, HEATING, TYPE OF COI
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OFi CONSTRUCTION ZONINO
AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION
Oli WORK IS SUSPENDED OR ABANDONED fOR A PERIOO OF 120 DAYS AT
ANY TIME AFTER WOfiK IS COMMENCED. NO. DWLG.
I HEREBY CERTIFV THAT I MAVE READ AND EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WOFiK WILL BE COMPLIED $1,501
WITH WHETHEF SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pEFM1T FEE
PROVISIONS OF ANY OTHER STATE OR �OCAL LAW REGULATING CON-
STRUCTION OR THE PERfORMANCE OF CONSTRUCTION. �SL.LS
STA�LS
OCCUPANCVIOAD
CU. FT.
STREET PARKING
IGAHAGES
$.75
AC CHARGE
Fire SC $1.50
�TAL FEE
�$53.50
SIGNATUA OFCON'RAC70AORAUTMOF112EDAGENT IDATEI EN ROP VALID T D THIS IS V UR PERM
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,�GNA U OFOWNEAUF NERBUILDER� IDATEi "-�- � B iNSO qaTE
NEW
ADDN
ALTER
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ConstructionAddress:
Effective 111/97
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AI�TD R-2 (v� ���j� °�t� ���C�
IiUILDING PERMIT APPLICATION �� �
I.egal Description: � ��, � �, � � �m � ��,— L � �y ,��� k �
r 5%!rF � 9 rce, �'?�L?c,
Owner Name & Address: _ ku� �- L. �tif_! �,S 7 ��- ,� �,C��.�n ,�. � Tel. � �`'j� �/��---
Contractor: k, , ��. �,,,� �, p� MN LICENSE �#
Address: 5° ��,S' �G �r �,,� s T- /� ti Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIP'I'ION OF IlVIPROVEIVIENT
LIVING AREA: I.ength ; Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width
OTHER: /� �" (� Hgt/Ground Sq. Ft.
�
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Construction Type: Estimated Cost: $ � 9'S ��� /
(�'ee Schedul e on Back)
Driveway C�rb C�t Width Needed: Ft. + 6 Ft = Ft �x $ —$
DA1'E: �� /`� � % A,PPLICANT: %�a=�X� Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOT'AL
S"I'[PULA"I'IONS:
$ �� ���
$ � .��
� .7�,
$
$
$
$
$
$
$ .5�� _ ��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$950 per SAC Unit
$S.QO (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ )
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[3UtLDING PERMIT FCE SCf-iEDUI.,E;
"I'iie Chief Building Official shail, before issuin� permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing buiidina ar
stiucture, 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 $500
$501 to $2,0a0
$2,001 to $25,000
FEES
$21 (Minimum Fee is $21 plus surcharge)
r
$21 for first $500 plus $2.75 for each additional $1(}0 or
fraction thereof, to and including $2,000
$62.25 for first $2,QQ0 plus $12.50 for each additional $1,0(�
or fraction thereof, to and including $25,Q00
$25,001 to $50,000 $349.75 for first $25,Q� plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,�0
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,�0
$1,000,001 and up
$574.75 for first $SO;OQO p�us $6:25 for each addirional
$1,OQ0 or fraction thereof, to and including $1(?0,000
� - --
$887.25 for first $100,000 plus $5.00 for each additionai
$1,D00 or fraction thereo��to .and including $5(�,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,OD0;000
$5012.25 for the first $1,000,0(� plus $2.75 for each additional
$1,0� or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete C�ub Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driv�way width plus 6 feet times $13.�0.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow �or pr��:;r
review of the proposed structure and of the construction site.
�� Ceriit5cate of Survey oi� tlie lot, showing the iocation of the foundation ��rlce it has it h�s heen c�nscruc��•?
�+'i�? l,c rcyuircd heforc ��r��cccdin� ���ith thc t�ramin��_
�.
Building
Inspections
763-572-3604
SITE ADDRESS �'S
TfiIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
v� YOUR E-MAIL
! h C 5� Y1 � �} �
❑ OWNER L1�COATTRACTOR
AnDt�ss: S � 3�'
PHONE: � { Z � 2Z � -�
N,�tv�: l �r �.e
STATE LICENSE # � B'Z '
annx�ss: '3'33 CP �
RE
PHONE lo
SINGLE FAMILY EW C(
❑ TWO FAMILY/NEW CON;
❑ ADDTI'ION
❑ BASEMENT FINISH
❑ DECK
❑ NEW
❑ MAIIVTENANCE/REPAIIt
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
�Ex oF sQuaxES Z�
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
� e�s�� �fi N� ci�r
��h1, c�eS `��, C�
; c{ O � EXP DATE
�� C a1 �r—
� � �—� FAX `� �4� ^
iTRUC' ON SIZE.
.UCTION STOF
O GARAGE/SHED
�ROOF
❑ SID1NG
❑ SWIlVIMING POOL
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
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❑ DRAIN 1'ILE
❑ OTF�R
Pemut No.: ��� " � I � �
Received By:
Date Rec'd: � �� � �� �����
WIDTH HEIGHT
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� SS„30�
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed fl�r plan
3. List of sWctwal members to be used
Ft.
SIDING FOR NEW CONSTRUCTION MCLUDING DECKS,
❑ Vinyl ❑Soffit ADDTTIONS. & PORCHES SUBIVIIT:
0 Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures
� Other ❑ Fascia and proposed project
WINDOWS 2. Two sets of construction plans
IIV EJQSTIIVG OPENINGS OYes ❑No L.(}CATION OF WINDOWS 3. Energy Calculations
OR FOR NEW OPENIIVGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WW�W TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING Tf� COST OF LABOR AND MATERIALS:
(USING THE 19 7 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ ,� �c�(p , OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
I Erosion Control
� Park Fee
Sewer Main Charge
Total Due
$ �'�- �S`� See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ ��.001 times the total job valua.tion
$ ( • .0005 x Permit Valuation Minimum $.50
$ • � $5.00 (State Licensed Residential Contractors)
$ $1550 per SAC Unit (Plans to MR/CC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ (, � Make checks aavable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that tt►e information above is complete and accurate; that the work will be in
conforinance with the ordinances aad codes o � ity of F' ley and with the Minnesota Construcrion Codes; that I understand this is not a
permit but only an application for a per ' an o' t to start without a permit; that the work will be in accordance with the approved
plan in the case of all work which r e a r s.
SIGNATURE OF APPLICANT PRINT NAME �N'l,,�L �SQ (` �� DATE CP f Z�e / ZGO rn
Page 2- Building Residential Applicaxion
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing pernuts for the erection of any building or
structure, or for any addition to any existing building or structure, or for any alteration or repair
to any existing building or structure, upott 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:
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
a11ow for proper review of proposed structure and of the construction site.
A Certifica.te of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building.Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977