AF - 47541�
•
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City of Fridley, Minn.
BUILDING PERMIT
Date: ...� M�Y 24, 1966
N° 8854
�'�. ����/
Ovvner: _. ._._. Builder _.._ HOI�DALE _BUII,DERS�. I'ftC .
3 017 LYNDALE AVEITUE SOUTH
Address._..._.._..._...._.._._.._______._........�...._._....___..____..__..._..... Address _.._..__. ..___.._ ._........__..
MINNEAPO�LLIS, MINNESOTA
LOCATION OF BUILDING
Na .._.__7678 Street ....._ JACKSOft STREET ft. E.____._..___._._. Part o! Lot _..._.._......
Lot ___.? ._..._.._..__ Slock _.._._.. 2.___._.._._..._.__. Additiou or Sub-Divlsion .... MEI,ODY,�,MANOR� 4th A]�pITI�,_
Coraer Lot .�__..__..._...... 7nside Lot ___.. ?�._.._..____.. Setback .�.. 35 �.._._�_ Sideyard __._ ���
Sewer Elevatiaai ..�....�$7.�_._._._......._.._....M...._...__...._..__ IIevatioz� . _. 890 �,5
TOP OF FOOTING �
DESCRIPTION OF BUILDING
To be Used aa:
_ DWF�.LING �t 40 �p� 24/30 geiglst ?4/30 �. � _ 1�___040 �, �, 20, 800
_.._.._...._....... _._._.. Froat ..� Deptt► xeight _........._.__ sq. P't. _ cti. P't.
_____.�
Type of Conatruction __..._.._._..F�ME __�_w_�_ Es� Cost _...._.. $16 , 5 00.._.._........ To be Completed _w_
SEWER LOCATION 80' South of Manhole
WATER LOCATION 70' South of Manhole
In cae�sideration o! the iasuaace to me of a permit to e building describe�l abave I s�a+ee to do
the proposed work in acx�ordance with the d�scriptian abov and wlth afl pravfdons o!
cu�dinanaes o! the dty o! Fridley.
Ia caodderatioai o! the paYa►ent oP a fce o!; 2�, . 00 ---- .., perrnit is h�ebY granted to HOMEDAI�E BUILDERS,
INCORPORATED to construct the building or addition as described above. This permit is grauted upan
the expre�s c�diti� that thepe reon to whom it is granted and hfa agenta, employees and workmen, in all wo�rk.
daz�e in, around and upon said building, or anyp� thereof, shall contorm in all reapects to tl�e ordiaencee o�
Fridley, Minnesota re8ardin8 locatio�, constructfon, alterati�, msintenance, repair and mo�vfn8 0! buildia�s
wio�� dty limits and this pe�rmit may be revoked at any ti�ne upo�n violatlon of an,y of the p�ovLato�ns oY iaid
WILLIAM H. SAftDIN B�� ��
NOTICEs
iMs p�e.h doa uet eewr fh� �qeoeliee, MN� 1'a� wie1�0. P��W f� M�Y� hwK er wabr. !� srn N s�
f6� lniWMY �n�1oe for �p�eaN P�tts fee fhw� �s.
J 4
APPLiCATION FOR BUILDING PERMI�
CZTY OI�.FRIDL�Y, MINNESOTA _
OWNER'S NAME . $UILD�R
ADDRESS AIyDRESS �4/ c�o-
, L TIOAT .OF .BUILDING _
N0. %�j,�� STREBT PART OF LOT _
LOT � BLOCK �� ADDITION OR SUBDIVISION� !��
CORNER LOT INSYDE�„LOT ✓ SETBACR �`�'- SIDE-YARD �/ � .
SEWER ELEVATION FOUNDATI011t EI�BVATIQN
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DBSCRIP'1'ION OF $UILDIPG �
To be used as ; -r e
. .
Front � O Depth � Height_ y�%
�� ��
Sq. Ft._ Cu. Ft. �-td�_�O C/
� �-�-.-.
Front Depth � Reight .�. , . . .
Sq. Ft. Cu. Ft. . ,
. 06
Type of Construction � , Estimated Cost ��i�O�, �i
, r-
To be canpleted_ ���� l� "" � fj' � � �
� -
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 Building�, and hereby
declares that all. the facts and representationa etated in this applfcation
are true and correct.
� � . . � � '" . � � � . . . �� . . � . . , .
T+^'
DATE / .z _���SIGNATORE
(Schedul f Fee Costs can be found on the Reverse Side). �
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Application �or Power PIaM�s and Heating, Coding, Yentilation, Refriger�ation and
Air Conditioning Systems ond Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work . . . . . . . . . . . . . . ... . . . . . . . . . . 8.00 �
Replacement of Furnace ............................. 5.00 �
Repairs & Alterations—up to $50Q.00 . . . . . . . . . . . . . . . . . . 5.00 $
Repairs & Alterations each add. �500.00 . . . . . . . . . . . . . . . 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU . . . . . . . . . . . ,
each add. 60,000 BTtT .... ......... ....... .. .
R.eplacement oP Fixrnace .............................
Repairs & Alterations—up to $500.00 . . . . . . . . . . . . . . . . .
Repairs & Alterations each add, $500.00 . . . . . . . . . . . . . .
8.00 ��
2.00 ;
5.00 $
5.00 $
2.50 $
3TEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ... .. 8.00 $
Furnace Sheli & Line—to 640 sq, ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . . . 2.50 $
Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 2.50 $
OIL BURNER—to 3 gal. per hour . . . . . . . . . . . . . . . . . . . . . . . . 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 $TU) . . . . . . . . . . . . . . . . . . . . . . 5.00 $ �/
GAS FITTING FEES: NO RATE TOTAL
lst 3 Fixtures ..................... x $1.5Q $ �
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU . . . . . . . . . , . x 2.00 $
AIR CONDITIONII�TG �
FAN HEATING SYSTEM 3ee Fee Schedule
YENTILATING SYSTEM
ALTERATIONS & REPAIRS TOTAL FEE `�
ROUGH
FINAL
Dept. of Bldgs. Phone 560-3480 ` �,
_.,..atinw /%CL' '%A' ��7,1✓�Y G' /'V k�L�! . i `� �-.
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City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application � true and correct.
Owner
Kind of Building ���
_.� ,. .�' .
Used as
To be completed about
. ! �v �
Estimated Cost, $ �� � R�
Old Ne . uilding Permit No. ��- ���i-- Permit No� �i
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0
DESCRIPTION OF WORK
HEATING or PLANTS---Steam, Hot Wa r, Warm Air—fiTo. �
Trade Diame � ="��•S�!_-C �(, �-�+'.���r-�' Size No.//��(�� ��C'
Capacity Sq. Ft. E.D.R BTLT H,p,
Total Connected Load �7�� �� � �` Kind of Fuel! ��' r
BURNER — Trade Name Size No.
Capacity Sq. F't. E.D.R BTIT g,p,
(REMARKS—OVER)
��<:
RAY N. WELTER HEATtNG CO.
S� ---�o-�-� e i i i��r� �.v�
N
gy_1Y11WblEAP�LlH 7. MlNNESOTA
Business Phone No- �yf ^� � � � %
City of Fridley 87 a, 01.
' Application for P'himbing and Gas Fitting Pern�it
Depl. of Bldgs. Phoae SU 4-7470
DESCRIPTION OF WORK '7�j78 NE Jackson
Number, Kiad and Location of Fixtures Lxation
y f: y�= w w w Z � � WATER HTR.
�� x � xy ZZ `�n 8Z V Z Ox (� Z
;� j �� � w 3� o� � LL O U�< 3 �°1 (�9 nS (� O i N GAS ELEC.
Base
ist c nn 1
2nd
3rd
4th
• Fulure Conaectfon Openiags Connected with
* New Fixtuse, Old Openiags I 3ewer �
Cesspool �
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
Number Fixtures ......................
Future Fixture Opening ................
New Fixture Old Opening ..............
Catch Basin ..... .................
Water Heater (Up to 200,000 BTLn . . . . . .
, New Ground Run Old Bldg . . . . . . . . . . . . .
NO. RATE TOTAL
— x $1.50 $
— X i.ao �
— x 1.00 $
— x 3.25 $
— x 2.00 $
— x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
lst 3 Fixtures .......................... x $1.50 $
I Additional Fixtures .................... x .50 $
Gas Range to zoo,000 sTtr . . . . . . . . . . . . . . 1 X 2.00 � 2 • 00
'i REPAIRS & ALTERATIONS—Refer to Coda
Description ................................................$
TOTAL FEE $ 2 .0 0
City of E`ridley:
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the facl
and representations stated in this application are true and correct.
Fridley, Minn 11 OC t 66 , 19_
owner Homedale Bldrs
Kind of Building I-r'
Used as rA Q
To be completed about 15 � C t
Estimated Cost, $ 5• � � _
]�1$-1�Tew. Building Permit No. Pe t No. ���
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By MI POLIS GAS CQ. �;
Business Phune No.
ROUC3H
FINAL
az 4M
C�ty of �dtey �
APPGcatioe �a` PI�9 and Got Fi�1i�g P�r�1al� 879.01
Dspt. of Bldqs. Pitons 5�0-3450
DESCHIPTION OF WOAlC
Numb.:. xiae aaa I,oeatioa oi Fixtuns I.mt�. 7678 NE Jackson St
���� IS���I�I��lo�l�
Base
lst
2nd
3rd
4th
' Fulur� Coaa�ct�oa Op�aiiW+
� x.w Fixtnr., old op.ninQ,
�'S�I�3�I�g�c�`��o
PARTIAL RATE SCHEDULE
WATEA HTR.
• •
/ N GAS ELEC.
City of FYidley:
The undersigned hereby makes application for a permit for ihe work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and niIing of the I?epartment of Buildings, and hereby declares that all the fact
and representations stated in this appllcation are true end correct
Fridley, Minn APri� 2, 19%0
___._, l9—
Owner R. Anderson
---1--- Kind of Building _frame
� � Used as residence
C�ss
To be completed about AAril 7, Z970
Estimated Cost, � 10.00
PLIIMBING Fi%TURE RATES: NO. RATE TOTAL Old XNew. Building Permit No.—_. _____permit No.
Number FYxtures x $2.00 $ �gned _ _
F�.�ture FYxture Opening x$1.50 $ By _ �"/J'1'�
New Fixture Old Opening x$1.50 a Business une No.
Catch Basfn ... x�3.25 a MINNEAP�US �� e�
Water Aeater (Up ta 99,000 BT[T) ..... x$3.pp�a
New Ground Run Old Bldg. . x�,� $ ROUGH
Electrtc W:t�s I�tt�r : aZ.00 : FII�iAL 1/�- /`n '%O
GAS FITTING FEEB: NO. RATE TOTAL
lst 3 Fixtures ..:... .... .............. a a200 ;
Additlonat l�ctures ..... .............. x i .7b �
caa itan�e to i�,000 s1'u . . . . . . . . . . . . . . 1 x as.00 � 3.00 Replace (1) R,ange
REFAI� t 11LTERA?io�aei�r !o Cod�
D�xipttoa .................................. . ...........�
1'OZ`AL FEE = 3 •�
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c�ty ofFr�a�ey
f AT T/IE TOP 41� TME TY►INY
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� rL-------, GOMMUNITY pEV[{.O�MENT OIV.
� � i M10TECTIVR NM�CTION 0��'f.
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Job Address
ner
Contractor
Kind of Buil
Comp etion D
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iW�ccr
7678 N. F. Jackson Street
Melvin G. Gulbertson
MINNEG�►SCO
ng
Frame
11-20-73
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PLUM�I�^Jr, PERf1IT QPPLICATI���r
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ss Phone
822-1752
ss P one
e MP�• MINN.
�es'
•10.00
P_lumbing Fixture Rates: N0. RATE TOTAL
Number Fixtures x $2.00 �_
Future Fixtures �^� x $1.50
—�_
New Fixture-Old Open. x $1.50
Catch Basin x $3.25
Water Heater-99,000 BTU x $3.00
Ground Run Old Bldg. x$3.25
Elec. Water Heater x $2.00
Gas Fitting Fees:
lst 3 Fixtures x $2.00
. �,
Additional Fixtures _� X $ .75
Gas Range-199,000 BT[1 _ 1 x$5.00 5.00
Repairs & Alterations
See
Description: Code
IState Surchart�e .50
� �la�s�°�i4�ur�cha[ge� ,50¢
I TOTAL FEE $ 5.50
!The undersigned hereby makes application for a permit
for the work herein specified� agreeing to do all work .
in strict accordance w ith the City Ordinances and rulin
of the Department of $uiidinge, and hereby declare that
a11'the facte and representationa stated in thia
application are true and correct.
�� � ��s�. ,—�o.c
��'Signature � '�— Date }
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CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991
6431 Universiry Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING� COOLING, VENT'ILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
Rate TOTAL
$ 20.00 $� �
$ 10.00 $
JOB ADD
���� �qe�.soN S� N�� ,
The undersigned hereby makes application for a permit for the work
herein specified agreeing to do all work in strict accordance with the
ciiy codes and ruling of the Building Division, and hereby declares
that all the facts and representations stated in this a licati n are
true and correct. �- '� � ,1991
�
OWN ER .� V i w= � f l�j wT.Sv�
�V 1�.�� � n " .
BUILDING USED AS ``� J'^� L��� �U�'i
$ 10.00 $ .
ESTIMATED COST I% OO PERMIT NO. %
"Air Conditioning - All Sizes $ 10.00 $
All Others/Repairs & Alterations (LIST ON BACK)
19�0 of Value of Appliance or Work � $
CommerciaUlndustrial
19�6 of Value of Appliance or Work
State Surcharge
TOTAL FEE
$
$ .50_
$_��,�
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONiNG PERMIT IS 515.00
PLUS THE 5.50 STATE SURCHARGE
REINSPECTION FEE $30.00
"Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
DESCRIPTION OF FURNACE AND OR BURNER
�
No. of Heating Units Circle One Steam) (Hot Wat arm Air)
Trade Name �c r Size I�:�f ��
BTU � HP EDR � _
Fuel Total Connected Load .�Z1�
Burner Trade Name Size No.
BTU HP EDR
��'� g5�TF1 AVENUC06UN3 yy� �� �c �.
HEATING COMPANY 4120
gRO�KLYN PA ,
Signed By ����.;3
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Approved By � Rough-In Date Final Date %
FILL OUT BACK SIDE FOR STACK VERIFICATION ON �� �
REPLACEMENT FURNACE
�
CHIMNl3Y 1lND STACR VBRIFICATION
The undersiqned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes (�No ()
2. Is free from rust or deterioration Yes (�No ()
3. Has no foreign objects lodged within Yes () No (�f'w�C„ "
�
4. Is securely supported Yes (�/� No ()
_ 5. Meets al•1 current Code req��irements f.or �
s�.-ze °$nc1 ta�a1- -BTLT � s cc�nnected Yes (Y) No O
6. Has total heating BTU's of `� SQi�i�
� Al l other BTU' s �� d� �
TOTAL BTU's � � �O � .
Remarks
v
List Alterations Beinq Done:
�
HEATING COMPANY
Signed By
Date
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HEAT LOSS CALCULATTCINS DEPAI2TMENT OF [NSPECTION I�liIVN�.APOLIS, MINN.
Weathersttips A• ••• Coa�trn+ctioa No. Inmlation
Guide
Windows Doar� Reference �7ut. Wail It�t. Wall CC#iin� RonE Floor ICind Ho�► Applied
Ye:— o I es— 0 19_ ,.
El.� Room I..eegth .�..-�iidtft Hei�ht Fl.� �. �l'ee�Eh Heitht
Windows and Doors--Craekagt �nd Area Window� and Doat�--�r��ticltdit aild l�tt�e�
tVidt� HdaRt No. ot LIt1�il � t � R��� WIdtE IiN�h! 0. Ot Ibwl tt. Mt
Tto, ot pana ot pane t�sht• ot crack . iq. iG No.� ot p�n• ot pan� IttA� � aL atROY� W. !G
� ��
' �-- � �
? 3 .a,., Cnef. $tn . , Coef. Btu
In6ltratioa In6ltration
G1ass ��
E�cp. wall F�p. wa(I
' Net ezp. wnil , .. ,:: ,.*:. . . . � . � c. , .:, 1�i1t ldtp, wall _ ,
Int. wafl Iti�. VviU
Ceiling Ceilie$
Floor fl�r
Total Btu. . Total Btu.
Required sq. ft. E.D.R. or sq�. �:. W.�1. L-�deit,:nve� R�quned sq. h E.D.R. at .�. �.A. L�t �i�ir .
Fl.I � Rooa+ i.,�e�t , 'QG'`�4h Height F1.1 Ei�ot�t l: ` "�► Ne�ht
Windo�+n and Doota�--Cra�a� a�t1 /�► , �G'it�daw� and Dao��lt� '� 1�1�5�: ,
wia�n •�sec Ita �t • �aca dtae e bai c rwi►
No. ot van• o[ O+�ni 14t7�ta bt 4rrtal[ �Q. tb Nd., ot ytn• et i�� It��fr , it otf�k tt.
� �
.i.—
. . �. . Caef : Bta . ,
Iafilcration Ia6ltratioa
Gl�ss � Cl�r� .
Exp. wall F�t�, wap
Net exp. watt /. Net e�►. wali �
Int. wall � _. inl. we11 . .
Cei�in$ . �/ �Ci�in$
Floor . "" Floor
Tdtal Btu. , . � .♦Y . ' ` T+�t�ri �
.
_ �.,. K..,. . ,.... ,.� �,. , . . ,.
. _ � ..
Required sq. ft. E.D.R or �. �n�. `�KI.A� �ea�tiyr �►� • R�►irEd �q. fE. E.d. oti. it�. ai�. W'.A.1:�..1�iNt ::,
_
Fl. E2oom t.e � �`�S1► Heighe EI. R�► I i.e� W�► ,
Windows and Doot:=--Ctaelc�j�t i�1 At�► Wiedowr rad i�s�s--CticlE�tt�r� �id �1i'ei► <
w�acn N�At a o Mi� tt, Ar�i dtn H*Nt a sL nal i
Ne. ot pan• ot �a� � lttpts .. 8t OfY�lk �. q. tt .. � .. N0. � et �1an• OL iM►M� .U� 6t� �. ot O�M
boCL. B�:I
In6ltration Iy►�tlttation
bOQi >
Glass Cdi[�
fsp. watl Exp. wai)
Net exp. wall � N+tt txp. wall ,
Int. wall Ie►�. wull
Ceiling • C�i1'tda
h loo� flbot
T�dtal Btu. T�a18tu. '
Required rq. ft. E.D.R. or sq, inr. QI.A. L.ewdet area Req+�ired sq. ft. ED.Ii. nr s�j, ies. �►A. Lradet �rea
ADDR ESS
OCCUPANT
HEAT LOSS
DATE HTG. INST.
HOUSE HEATING TEST RECORD
APT. F100R CITY SUBURB ' '
OWNER
SOLD 8Y INSTALLED BY
El�chical Work� BY Gos Lin� Br —
TYPE OF HEAT GA FA `' HW STEAM SPACE HTR.
GAS DES�GN
MAKE _�` :MAKE OF BURNER
Mod�l � ' � 1lbdel
S�tiol ' � , ,t , , , _I ,_; _� Max. BTU Ratiny
INPUT - - ' `"'- ' •J �� : MAKE OF FURNACE _
Mod•I
UNIT HTR. OTHER
CONVERSION
CONTROLS
THERMOSTAT r' E '} k�a► Pluy �*;x _. V�nf Siz�` i=
Valv t' t: KIND OF LINER -'�' j� SIZE�NONE
Limit `°' � �� Droft Hood Rpulawr
Limit S�ttiny :,.,\ Fih�rs' Si:� f�- ':.,/.} nly�b��
Fon 5ettiny ( # Chimn�y Loeation tns��T,TOutsid�
� ( ' �.
Pitot TYP� Chimn�y Const�uetion ` ` _ � '
Pilot Make �
Pilot Modsl $mok� Bomb ' Wi�iny
Pilot Timi�9 Draft % � ' '" ` T�sf Tay �'"� �
L.W. Cut Off Doo� Pressws Liy6tiny Ins�
i i
Prossure ` P�re�nt CO �� �f Dat� Tsst�d " ` ' ��
Input CFH ,'� � T P�re�nt OZ ,', '' Company Testing �- " P ? � f '�'` � i." (
r� f J
Stack T�mp. �`'"� P�re�ot CO � Nam� of T�:t�r z " z F -- �
Form 235 , ,. ;�' .
Building
Inspections
7b3-572-3604
763-502-4977 FAX
DATE�SITE ADDR SS _
THIS APPLICANT IS:
��
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-09
YOUR E-MAIL ADDRESS
�1�s a.v �� . i(J � �
❑ OWNER OCONTRACTOR
, aC/ , r�•t/
PROPERTY OWNER/ NAME: o�h , r�,�/
TENANT ADDRESS: �L � Jit�Sb�t�/IIE ��Ty +�
PHONE:_ �S /� ?0.3 �I3�/ �t'
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING
Permit No.;�UU y�' �-/'�v �
Received By: ,
Dat��:��� � � Z���
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STATE LICE SE #�aG Z$% S� • EXP DATE 3
ADDRESS: �%/A7 G�����.✓r+' Gl�ati., CITY',�r�
Pxo�'7G3- �► �fii.�i/�"S6. FAX 7%�3��qd—
ffi�INGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILYMEW CONSTRUCTION STORIES�
❑ ADDITION ❑ RAGE/SHED O WINDOWS
❑ BASEMENT FINISH ❑ DRAIN TILE
❑ DECK IDING O OTHER
❑ SWIMMING POOL
O NEW HOME CONSTRUCTiON C]
❑ MAINTENANCE/REPAIR �
/z �/lU
fAT$+ll�f/LIP 3�"30
2zsq s�-J.�
HEIGHT SQ FT
ROOFING ❑�� SE ONLY BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES 2� fd'HOUSE & GARAGE I, Existing Ffoor Plan •
GARAGES ❑�� �ACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: fia'DETACHED GARAGE 3. List ofstructural members to be used
PROPOSED HEIGHT:
S G FOR NEW CONSTRUCTION INCLUDING DECKS,
�nY� �j OSoffit ADDiTIONS_ & PORCHES SUBM[T:
0 Aluminum ❑ Trim L Site Plan/Survey showing the existing structures
O Other � ❑ Fascia and proposed project.
2. Two sets of construction plens
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS �Yes �No LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WiNDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
COTAL JOB YALUATION $ I�� IQ,7j �_ _ 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
$ +���r%� See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$���'{�� .001 times the total job valuation
$ S�3a .0005 x Permit Valuation Minimum $.50
$ �yq� $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 checks pa able to: Ci of Fridle Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply far a building permit and ! acknowledg t at the information above is complete and accurate; that the work will be in
conformance with the ordinances a codes of the City f F idley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an applicatio fo a pe ' and or �s ot to start without a permit on site; that the work will be in accordance with the
approved plan in the case o I r w re ' e e'ew and approvat of plans.
SIGNATURE OF APPLICAN PRINT NAME ��C` //r�'J � DATE ��