AF - 47388•
�
City of Fridley, Minn.
BUII.DING PERMIT N°• 3 2 4 3
Date: . . . .� .°. ��' .�� . . . .. . . . . . . . . . . . . . . .
Owner . . . . �.� i�: W, :�?:%:�:ti.,�t.c'. .✓. .� Builder . . . . . . . . . . . . �l.�;Ll �r� C.� :� . . . . . . . . . . . . . . . ..
Address �. .��. . Q. �. . °�� �L� ; . � . Address . . . . . . . . . . . . . .. .. ��:`.4-4-� . . . .. . . . . . . . . . .
�1n . /7 ha��L. �
� LO�CATION OF BUILD[NG
�% .
No. . ."'3.`.�! . . . Street . �": �. . � .. . . .. . . . . . . . . . Part of t . . . .. .. . . . . . . . . . .
, �/,/� rj� /' ���,�� r
Lot � �: : Z b �: . I Block . . �. . . . . . . . . . Addition or Sub-Division . . . . . .`�: 4 t.L.C/. , Y.�'2 ;? Zr. r . . . . . . ��t •
/ � � . ..
Corner Lot . . . . . . . . . . . . Inside Lot . . . . v . . . . . Setback ..-�.9? . . . . . Sideyard . ..� Q. . . . . . . . . . �, .S . . . .
DESCRIPTION OF BUILD[NG
To be Used as:
. . ��"�'�'�:1l�� . . . . . �oxrt ,.� 8 . �� ?: . �. . . Height . . . f.1. . . Sq. Ft. . . [ . � . . G�. F't. � l . .�
r �X�
Front ........ Depth ..... Height . .. ..... Sq. Ft. ..... ... � Ft.
Type of Construction ��: �!�Q,-!. . . . . . . �s� Co�t. l7.-,c .� �. �. . . . . . . To be Completed . �%: �:a . . . . . . •
�.-e..��...� � " �
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In consideration of t'he issuance to me of a permit to construct the building desribed above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all proviaions of
ordinances of the city of Fridley.
X. . ��,.-�- . . . - . : .' . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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In consideration of the payment of a fee o! $..':'."`.....:, pernut is hereby granted to ...'i�.. .. i-�°.�-:�
......................... to construct the building or addition as described above. This p 't is granted upon
the express condition that the person to wham it is gi�anted 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, maintenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisfons of said
ordinances. �
�J / �
. . . � . . .':'. .'. � . �./." �. :�1� �-�? � Builcling Inapecbor
NOTICE:
This permit does not cover the construotton, instaliation or a,lteration for wlrin�, plumbinp, gas heating,
sewer or water. Be sure to see the Buildlny Inspector for separate permits tor these items.
t
City of Fridley, Min.n.
BUILDING PERMIT
N° 53�s�
Date: _.......�".�:�.'.'..� �F..._.._..._. .–• - --.._......•--•—._
I
Owner: : ._ Builder •-•-------•--•.._ .__.--------•-•---•-•---•---•----._..._......._-•---...------.._.--•-------
Address...__ ..............._...._._.__..__._.._.._ .._....---------....----------.._.-----.....---._ Address ._.. ...: ' ..... . •�•-------.....__.._.._....___.._..__.._......._
L ATION 1 ING
No. ..���W��Street ...._.. .:. ' ._--- •_.�t.-.. Part of Lot ....._.._.._...._.._.._.___-.....--•_--_.__...___...
Lot ....._.....�......_......_...._ Biock .._.._..__------•------_..-----_.... Addition or Sub-Di �ion� .-------.--_._........._.._-•-----._..._� S, w_- - _._..�
!
Corner Lot .___......_...._......_ Inside Lot _..._.._..- ----• Setback ..... . Sideyard •-._.--..�.-_._...._._._._._......._.._._.._._
� _. _. �....___. _
Sewer Elevation _.._.._.._...___...__._..._..._.___._...._.:._._.._._...._.._..._._ Foundation Elevation ....._.._.._._..__.....__._. ���_—,
DESCRIPTION OF BUILDING
T as: `
.. Front �.----. Depth �.�... Height �..._ Sq. Ft��.. Cu. Ft ���r^�a.'
_____.__ ......._._.___._.__-- -_._._._._._ Depth _._ : � He' ht ...___ Sq. Ft _.___.�.__ Git. FL _._.
Tj�pe of Construction ..._._ ...rr."'j0��.. Est. Cost ..
. ..._�o be Completed _.__....__.�... _.�
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 payment of a fee of $ ._._._...__..._._, perxnit is hereby granted to._.._....__
....._._.........._...._.._.._......_...._._.__...._..... to construct the building or addition as described above. This pernut is granted upon
the 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, shall conform in all respects to the ordinances of
Fridley, Minnesota. regarding lceation, construction, alteration, maintenance, repair - and moving of buildin�s
within the city limits and this permit may be revoked at any time upon viola��v�ny of the provisions of said
oTd'1riAAce& .rr�+� ,. dr
$llll�ll$ �S�CCtOT
NOTICE:
This pannh doss no1 eovsr fh� cen�rucHon, insiallaHon fo� wf�ing, plue�bing, gas 6tafinp, s�w�e or w�Nr. B� sur� M sN
th� Bvilding Inspeetar for »paraM p�rmils for fhea it�ms.
: �a ! �� � � !�� � - =�
..-- .
APPT,ICATION FF'0� BIIILDING P�RMIT
C IT3C OIF FR.IDLEY, MINNESOTA
Owner's Name a ►n � r Q Builder � u� tn�-� v� /
�ictdress % � S �1 T��►e k s o �n �V � �dc]ress � � w-. s�..
IACATION OF B LDING
No. .� . � � � 3treet • - Part of Lot
Lot Block Addition or Subdivision
Corner Lot Inside Lot Setback Side-Yard
S�. ELEVATI0�1 FOUNDATION ELEVATION �
Applicant attach to this form Certificate of Survey oP Lot and groposed buildiag
location.
DFSCRIPTION OF BIIILDING
To used as:
' %� �D
t Front"��}'�'_'Depth�_,�„_Height
Sq. Ft. e� Cu. Ft.
F`ront Depth Aeight
. Ft. Cu. Ft.
0
Type of Constxuction Estimsted Cost �� r----�—�
To be Completed
The undersigned hereby makes applica.tion for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City Ordinances and ruling oY
the Department of Buil.dings, and hereby declaxes that all the facts and repreaentationa
stated in this application axe true and correct. `
DATE , '--' "�' SIGN�.TIJRE
(A Schedule of Fee Coste can tre found on the Reverse Si .)
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SUBJECT
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 DEVEIOPMENT OIV.
� ��: - --
r � � PROTECTIVE INSPECTION SEC.
� . ,
l--_-�� �"' �'� CITV HALL PFiIDLEv 55432 NUMBER HEV. DATE
i 612-571-3450 910-F15 8/22/88
JOB ADDRESS 6357 Jackson Street N. E.
1 LEGAI. LOT NO. BLOCK TRACT OR ADDITION
DESCR. pt,2'7,2g,p ,2g, 5 Florence Park Addn, to Fridley
2 PROPERTV OWNER MAIL ADDRESS Z�P
Schulze 6357 Jackson Stseet N.E.
3 CONTRACTOR MAIL ADDRESS Z�P
D& D Home Impxovenlent Inc. 7401 Central Z�venue N. E.
4 ARCHITECT OR DESIGNER MAIL ADDRESS Z�P
5 ENGINEER MAIL ADDRESS ZIP
PAGE OF
� �
N° 19643
�99GG
APPROVED BV
SEE ATTACHED
SHEET
572�0680
PHONE LICENSE NO.
784-7543
PHONE LICENSE NO.
PHONE LICENSE NO.
6 USE OF BUILDING
Res iden tia 1
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION C� REPAIR ❑ MOVE ❑ REMOVE
8 OESCRIBE WORK
Reroof House & Garage (19 Squares)
9 CHANGE QF USE FROM
TO
STIPULATIONS
Roof ing can be the 2nd layer but not the 3rd,
TYPE OF CONST.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AtR CONDITION�NG.
THIS PERMIT BECOMES NULL ANO VOID IF WORK Ofi CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 60 OAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWIG. UNI
I HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO B€ TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEFiEIN OR NOT. THE GRANTING OF A PERMIT $�SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEfiMiT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFOfiMANCE OF CONSTRUCTION. $ZrJ.00
�/ _ t� �� oi eu ruGr� cc�.
SIGNATUFlE OF CONTRACTOFl OFl AUTHORIZED AGENT IDATEI
SiGNATURE OF OWNER iiF OWNER BUILDER� 1DATE1
OCCUPANCYGROUP �OCCUPANCYLOAO
CU. FT.
OFFSTREET PARKINC
STALLS GARAGES
SURTAX
$.5Q
I TOTA� FEE
$25. 50
Y jY1�LIpATED THIS IS YOUR PERM
I�W [ ]
�1�UN [ ]
ALZER �
City of Fridley
R-1 Ai�ID R-2
Building Permit Application
Effective 5/L88
Cbnstruction Address: �.3 J� � c So.t/ „� i� '
Legal Description• � -
Owr�er Na�ne & Ac�lress : � Tel. #�'7� -CS 6Sd
�ntractor: � o pr�v e c- �, ��- f-7.�{3
Aaaress: __ ��� f C�e� f-��( .�.U� � �/�
Attach to this appl icatian, a Certif icate � S�irvey of the
lat, with the proposoed vonstructi� dra�m on it to scale.
�'.SQtIPPI(�1 0� IN�'ROVl�l�
LIVII� ARFA: Length Width Height St�. I�t.
(�RAGE ARF.A: Length Width Height �. Ft.
D�QC ARFA: Length Width Hgt/Grould �. I�t.
�:.
onrner Lot [] Inside Lat �(1 Ft. Yd Setback Side Yard Setbacks
' 0�..�
Type of �nstruction i�j�� e• haK s e���q e� !'i a Fstitnated Cost : S`� q S
Approx. Comple�tion Date: _ �- 30
AI� A Alt. B
Prop�sed Driveway Width If New Opening Is Desired: 8 $
Width + 6' See Back Page
IY�1TE: `���'-I ^� $ APPLICANP: (•� Q ��e�/
Aeanit Piee
Stat�e Surcharge
SAC Qzarge
Driveway Escrav
Park Ppe
Sewer l�ain C7iarge
To►r�
Sl'IPtII.i�I�:
`M Y 1►i� 1].`i ��� � �'�
S �:� _ C�(�
S ��
S
$
S
S
S �S , s?l
�.. : `��'�-��
P+ee Schec�le on R�verse Side
$.50/51�000 Valuation
$550 per SA+C Unit
Alt. �A• OL P11t. "B" AI7We
F�e Determired by F�gi�ering
Agreeaer�k Neoessary [ ] No�t Neoessary [ ]
SUBJECT P •�
City of Fridley 6 35 8
AT THE TOP Of THE TWINS g U I L D I N G P E R M I T
r
� ` RECEIPT NO.
� ' COMMUNITY DEVELOPMENT DIV. °'
r �,: ----- , . �6 ��
� � PROTECTIVE INSPECTION SEC.
� �
� � /"'1 � CITY HAIL FRIDLE� 55432 NUMBER REV OATE PAGE Oi AVPAOVED Bv
�"°� � ,'' 612-571-3450 910-Ft5 6/25/98 � /
JOB ADDRES5 6357 Jackson Street NE
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
oescR. 27 , 28, 29 5 Florence Park Addn to Fridley SMEET
2 PHOPERTY OWNER MAIL ADDRESS 2iP PMONE
Diane Brazil & David Schulze 6357 Jackson Street NE 572-0680
3 CONTRACTOR MAII ADDRESS Z�P PMONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADOFESS ZIP PNONE LICENSE NO.
5 ENGINEER MAII ADDFiESS ZIP PMONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION [� REPAtR O MOVE ❑ fiEMOVE
8 DESCRIBE WORK
Partial reside of house (STORM DAMAGE)
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE Of CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBiNG, HEATING,
VENTILATING OR AIF CONDITIONING.
THIS PEFMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 2pNING S�. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOp A PERIOD OF 120 OAYS AT
ANV TIME AFTEFi WORK IS COMMENCEO. NO. DWLG. UNITS OFFSTREET PARK►NG
1 HEREBY CERTIfY TNAT 1 MAVE REA� AND EXAMINED THIS APPLICATION 1 STAILS GARAGES
ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yq�UATION SUpTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED @ ���p
WITH WHETHER SPECIfIED HEREIN OF NOT. THE GRANTING Of A PERMIT W8OO ,'.onn �.SO
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL THF pEqMIT FEE SAC CNARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATtNG CON- $29.25 Fire SC �.HO
STRUCTION OR TNE PERFOFMANCE OF CONSTRUCTION.
PLAN GHECKFEE TOTAI FEE
$30.55
S�GNATUREOFCON�AACTORO UTMOR�ZEOAGENI IDATEI WHEN PROPERLV LIDATED THIS IS VOUR P RMIT
�Je�.�s�. � � b-aS - 98 L(/, cyr7� —'
SiGNATUF7E OF OWNEA i�� OWNER LD Ri �OATEi Bl0 �NSP O�TE
NEW
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
�?� 3� �
3� �,.3
ConstructionAddress: �03� % J ac1�S �n �'�' . W�
Legal Description: �.� ��. � a-- `a e1 �� �C k � 'F� o� c�c e P a�1Z _
Owner Name & Address: �� o��n e Q �c�Z. �\ ��0.� ;�-- �CSn��2� Tel. # S� a' 4 b� d
Contractor: MN LICENSE #
Address: . Tel. #
Attach to this application, a Certiitcate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: L,�ngth Width Height Sq. Ft.
DECK AREA: Length Width � HgdGround Sq. Ft.
OTHER: po���tc�.� ' d`eS�.C�-e o c� ho�� s�or� c�e��aqe
Construction Type: Estimated Cost: $ g bb •�'
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: (� a5 - g� APPLICANT: � ^ � Tel. # S7 a- d b� �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License 5urcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �� �S"
$ . � C�
$ , �C)
$
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 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 [ J
$ �o.Ss
.
�ZS�So
Building MECHANICAL Permitivo.��� 't-��3`lG
Inspections RESIDENTIAL APPLICATION Received B:�.
763-572-3604 CITY OF FRIDLEY ��e��
763-502-4977 FAX EFFECTTVE �-i-oa
DATE O L� b YOUR E-MAIL ADDRESS
SITE ADDRESS �Q"jS '� JaG�CS 0''1 S'E N�
THIS APPLICANT IS: ❑ OWNER �CONTRACTOR
PROPERTY NAME: .DU�I 2. SC rl �l..I Z e.
OWNER/ ADDRESS: %�J' S� ,.�CIC.�SOr1 S'� /U� CITY ��"ip��Q1,� STAT�I.N ZIPSSK3L
TENANT
PHONE: � {� -S ( l� � Z� �j �
CONTRACTOR COMPANY NAME: -{i �
NOTE:
SEPARATE CITY CONTACT PERSON: S� W\C�
LICENSES ARE STATE LICENSE # EXP DATE
REQUIRED FOR GAS
AND HVAC. ADDRESS 1S6 ( W I1i' ,r� :� CITY� t�0. STATE�'�N Z�
SUBMIT COPY OF BOND pHONE I SL- s�S-�% li FAX gS`Z-"�j(�"1 - Q' I I O
AND INSURANCE
PERMIT TYPE �SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � NEW �REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK �l�--�(J �A C.�. �} G•
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, exc(uding the fixtures. (This should reflect only the cost of labor )
OR
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW) ,�t
Equipment Installed MFG: G'�'� MODEL: � 6�� d Z1 SIZEBN 2��
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZEBTU
%�A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGF/OVEN $10.00
_AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $]0.00
_BOILER $35.00 _FURNACE $35.00 _GAS UNTf HTR $10.00
_CHIMNEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
�_ � F�� —
Permit Fee $ . �� Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ _
TOTAL DUE $ OR Number of fixtures @$25.00 f x$25.00 =$ 2S • o0
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
MINIMUM $15.50 MINIMUM $15.50 Tota1= $ ZS- So
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a mechanical permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances
and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a pertnit and work is not to
start without a permit; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAMEU/o i i DATE $ Z° a 8
APPROVED BY DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
3uilding
[nspections
763-572-3604
763-502-4977 FAX
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-08
�ATE ��� b' U� YOUR E-MAIL ADDRESS
iITE ADDRESS �0�.� 1 ��L�-��t1 ��' �� �
I'HIS APPLICANT IS: � OWNER ❑�UNTRACTOR
PROPERTY OWNER/
TEi�1ANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
Permit N
Received By:
ADDRESS: �35� ��C�r-Sd`n S��ITY F�:C`��ev_ STATEI'�YIiZiP_`�
PHONE: 11n�— S7��U �R�
ADDRESS: CTTY STATE ZIP
PHONE
STATE LICENSE #
C�3'�INGLE FAMILY/NEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUCTION
❑ ADDiTION ❑ GARAG
❑ BASEMENT FINISH �OOF
❑ DECK ❑ SIDING
❑ SWIMM
❑ NEW HOME CONSTRUCTION
❑ MAINTENANCE/REPAIR
DESCRIBE WORK BEING DONE: r
ROOFIIVG
NUMBER OF SQUARES ��
GARAGES ,
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
O V inyl
� Aluminum
0 ocn�
WINDOW S
IN EXISTING OPENTNGS ❑Yes �No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
FAX
6XP DATE
SIZE
STORIES
:/SHED � WINDOWS
❑ DRAM TILE
❑ OTHER
NG POOL
❑ ADDITION
❑ REMODELING
O HOUSE ONLY
G�UUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
BASEMENT REMODEL[NG SUBMI'f:
I. Existing Floor Plan
2. Proposed floorplan
3. List of swctural members to be used
POR NEW CONSTRUCTION MCLUDING DECKS,
ADDITIONS & PORCHES SUBIvDT�
❑Soffit 1. Site Plan/Survey showing the existing structures
❑ Trim and proposed project.
❑ Fascia 2, Two sets of construction plans
3. Energy Calculazions
LOCATION OF WINDOWS
OF
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
���SI�1G THE 1997 UBC FEE SCHEDULE)
COTAL JOB VALUATION $ J OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$ (7
$
$
$
$
$
$
$ _
See Back Page for Fee Schedule
65% of Building Permit Fee .
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1825 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 checks �avable to: City of Fridley
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
Attach
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes
of the City of Fridley d with the Minnesota Construction Codes; that 1 understand this is not a permit but only an application for a permit and work is not to staR without a
permit on site; that e w k wil e in accordance with the approved plan in the case of a11 work which requires review and approvat of plans.
SIGNATURE OF AP ANT�c� ���►,� �.Q PRINT NAME� o.v� � SC�v`Z� DATE �`�(o
r,. �,.
. . . . • � : ����� � .