PRE 2010 DOCSCity of Fridley, Minn..
BUILDING PERMIT N® 6490
Date: /'5 '-s e
r'
Owner: Build.,,
Addr.-!Y,--.—• .
L CATIO F BUILDING
No. L Street Part of Lo
Lot _ _ _ _ __ Block Addition or Su on . L��.El�a.�+fp
Corner Lot _ Inside Lot �� &dback _ _ Sideyard
Sewer Elevation _ __ . F dation Elevation
DESCRIPTION OF BUILDING
T as:
Front Depth Height V Sq. Ft. Cu. Ft. o!._D
Fro n Depth Veight Sq. Ft. Cu. Ft.
Type of Construction Est. Co __ To be Completed _
In consideration of the issuance to me of a permit to construct the building des cri above, I agree to do
the proposed work in accordance with the description above set fo and in compliance th all pro ons of
ordinances of the city of Fridley. �/r 1) A
In consideration of the payment of a fee of -- *J , permit is hereby granted to—
to
oto construct the building or addition as described above. This permit 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 location, construction, alteration, maintenance, repair and moving of buildings
wry the city limits and this permit may be revoked at any u�pan violation of any of the provisions of said
NOTICE:
Yui• permit doss not cover t6 construction, installation for whine, phnnhine, gas uoetine, sewer or water. Be sore to see
tw Beihdne hup ewr for aparate pwn*s for them beim.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
(3WNE-It' S NAME
ADDRESS �� �� � � � �. ADDRESS
LOCATION OF BUILDING
No. Street Yart of Lot
Lot �� Block Addition or Subdivision
Corner Lot Inside Lot Setback Sida Yard
SEWER ELEVATION
FOUNDATION =VATfON
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as;
Front® Depth' Height
Sq. Ft. Cu. Ft.
-e?l. zy
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construct
To be Completed �,�
Estimated Cost D®00
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
rulings of the Department of Buildings, and hereby declares that all theacts and
representations- stated in this application are true and correct.
DATE / A?V� SIGNATURE
104,
(Schedule of Fee Costs can be found on the• Reverse Side.
oto -
City of Fridley, Minn. N.o
7793
BUILDING PERMIT
Date: June 9, 1965
owner: Virgile D. Werner Builder Virgil D. Werner
Address 6341 Madison Street N. E. Address Same
LOCATION OF BUILDING
No. 6341 Street Madison Street N. E. Part of Lot
Lot 15 __ Block 6 Addition or Sub-Dividon Christie Add.
Corner Lot — Inside Lot Setback __ _ Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front Depth Height Sq. Ft. Cu. Ft
Front Depth Height Sq. Ft Cu. Ft.
Type of Construction Est Cost 63500,00--- To be Completed
Storm damage repair
In consideration of the issuance to me of a permit to construct the building cribed above I agree to do
the proposed work in accordance with the description above orth and in c o p ce with provisions of
ordiaancxs of the city of Fridley.
In consideration of the payment of a fee of $ 10..E _,, permit is hereby granted toY;, g; l WeM=
to construct the building or addition as described above. This permit 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 ��gg location, construction, alteration, maintenance, repair and moving of buildings
within the city limit This permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Allen Jensen Building Inspector
NOTICE:
Thh penult don not sever the constwat w, hataMon for vAWn& phmbine, ®n haft, awer or wafer. Be aro to no
the BWM'nB bupedor for sepneM permhs for thea hens.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAM" ILDfR
No -
OF BUILDING
Ol/ 1.
of Lot
LOT BLOCK j6 ADDITION OR SUBDIVISION
Corner Lot Inside LOT Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To be used as;
DESCRIPTION OF BUILDING
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth ^Height
Sq. Ft. _ Cu. Ft.
Type of Construction Estimated Co
To be completed.
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 rulings of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
DATE �' �� SIGNATURE,��
a
(Sc dule of Fee Costs can be found on the Reverse Side).
City, of Fridley, Minn.
BUILDING PERMIT
Date: AP41 11, 1966
Owner: Virgil D. Werner Builder Ofsner
Address 6341 Madison Street N.E. Adm
LOCATION OF BUILDING
No. 6341. Street Madison Street N. E. Part of Lot
Lot i5 Block 6 Addition or Sub -Division .... - Christie
Corner Lot __w____ inside Lot — S Setback _ - Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
a3-207
N? 8755
To be Used as: tani3y roomm
Bedroom or Front 1O Depth18 t Height 10 t Sq. Ft. 180 Cu. Ft 3,p Q.
rear ent T Aad Front 71 Depth 12 t Height 10 t _ 9q, Ft — L cu. Ft __840
Type of construction Rod fkafne Est. cost —"5Q-.— To be completed 7.111,1 h6
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 f and in comp ce with ail provisions of
ordiaanoes of the city of Fridley.
In consideration of the payment of a fee of $_.!!O—O, permit is hereby granted toVirgil D.
Tilymer to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it ie granted and his agents, employees and workmen, ffi aII work
done ia, around and upon said buildtag, or anyctipoanrt thereof, shall conform in aII respect$ to the ordinances�of
Fridley, Miaaesota regardiaa Pe�otn,�3► be revoxed�at aaY time upon�ol�ation�� tviei bo of said
�� city limits sad tis
ADEN G. JENSEN Building inspector
NOTICE
fhb psrmb dos not sorer the const affim, instaffatbn for Y bb& plumbing, gn hadho army w water. Be sun to as
the BuMbg ftgm for for opm to penft for thea Nan•.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA:
7 PA
ADDRESSADDRESS
.LOCATION OF BUILDING
N0BEET / _PART0 LOT
LOT 457' BLOCK ADDITION OR SUBDIVISION
CORNER LOT INSIDE LOT """'SETBACK kM-YARD
SEWER ELEVATION FOUNDATION ELEVATIM
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
0�
To be used as:
Front /D Depth /� Height_
Sq.. Ft. /J110 Cu. Ft.
,AA Z,:7?& ice, Front Depth / 2-' Height
01
Sq. Ft. 6 7` Cu. Ft.
eo
Type of Construction ` &,,y Estimated Cost •� `J" (�
To be completed
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all -work t strict accordance with the City of
Fridley Ordinances and rulings of the`Departmeat of Buildings, and.hereby
declares that all the facts aid representations stated in this application
are true and correct.
DATE SIGNATURE M
(Schedule of Fee Costs can be found on the everwi Side).
Application 4�or'owar Pants and HoaNne,�, Cooling, Yentilotioes Rellhp*lullen and
Air Condftnbq Sydem and Desks
PARTIAL RATE SCHEDULE
GIIA.VM WARM AIR:
NATE TOTAL
Furnace Shell & Duct Work ................
.. $10.00 $
Replacement of Furnace ....... .....
6.00 $
Repairs & Alterations—up to =500.00
... 6.00
Repairs & Alterations each add. $500.00
3.00
NECIL WARN AIB
Furnace Shell & Duct Work to 190,000 BTU ......... .. $10.00
each add 60,000 BTU .................... .. 3.00 =
Replacement of Furnace .... 6:00
Repairs & Alterations --up to ;5x00.00 6.00 ¢
Repairs & Alterations each add. $M.00 .... .. .... 3.00 ;
STEAM o: HOT WATER SYSTEM
W
Furnace Shell & Lines—to 400 sq. ft. EDR Steam
$10.00 $.
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water
10.00
Each add. 200 sq. ft. EDR Steam
&on
Each add. 320 sq. ft. IDR Hot Water
3,00
OIL BURNER—to 3 gal. per hour 6.00 S _
over 3 gal. per hour—See Fee Schedule
City of Fridley:
The undersigned hereby makes application for a permit for the work :hereiir
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley. Minn_ / — /6
Owner U y ).11 ) �,1� 2L� j
Kind of Building
Used as - _
To
Estimated Cost,
DEd08EMON OF wow
BEATING or POWER PLANTS— 1ieam, Hot Water. Warm Air—No .
GAS BURNER (up to 199,000 BTL) ...
W
Trade Name
She No
GM 199,000 BTU See Fee Schedule
R 1t j
GAS FfTTING FEES:
NO RATE TOTAL
Capacity Sq. n E D R
BTU gp
1st 3 Fixtures . . .. . .....
x$ 7.00 E
Total Connected Lead
Rind of 1Mel
Additional F7izttaes ..
s .76 i
0s
&00
_; i
BURNER — Ttade Name
Size N&
AIA CONDITIONING 2119
_ o . 0
Caped Sq. Ft E.D R-
BTU �p
TING STNIM See Fee SehedWe
VEIMATING SYSTEM
$
ALTERATIONS & REPAIRS TOTAL PER $,Z -4t
.
ROLIOA
tstau►ses—oveRl
W--
W
�.
--
M
1low L�/
R 1t j
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FIT'T'ING PM41T
PARTIAL -RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
m
TOTAL
.Number Fixtures
X
N
$
Future Fixture Opening
u
$2.00
$
d+
New Fixture, Old Opening
Water
A
�m
q
A
G .c�
y'4
x
$5.00
$
p,
(y
X
$5.00
Heater
100,000 BTU to 199,000 ETU
b
$10.00
$
df
Water Softener
'� C
$7.00
w
u
8'x
x
$5.00
$
aui
Electric Water Heater
X
$3.00
W
W
GAS FITTING FEES:
•ri
1st 3 fixtures
x
'$3.00
$
Additional Fixtures
ci
$1.00
o
-4
D
X
w
ai
vi
3
$4
4
Qwo
�i
1-4
U,M'4?
First $100,00
0
?
�
as
lec
$2.00
l
State Surcharge
$
.50
T
TOTAL FEE
$9-6-0
1st
2nd
3rd
4th
(R) = Future Connecticn Opening
Connected with Sewer
(+) = New Fixture, Old opening
Water
PARTIAL -RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
.Number Fixtures
X
$3.00
$
Future Fixture Opening
x
$2.00
$
New Fixture, Old Opening
X
$2.00
$
Catch Basin
x
$5.00
$
'Pater Heater - to 99,000 BTU
X
$5.00
$
100,000 BTU to 199,000 ETU
X
$10.00
$
Water Softener
x
$7.00
S.
New Ground Run Old Building
x
$5.00
$
Electric Water Heater
X
$3.00
$
GAS FITTING FEES:
1st 3 fixtures
x
'$3.00
$
Additional Fixtures
x
$1.00
S
Gas Range to 199,000 BTU
X
$10.00
$
REPAIRS & ALTERATIONS
First $100,00
.$5.00
$
each add. $100.00 or fraction
$2.00
$
State Surcharge
$
.50
TOTAL FEE
$9-6-0
REINSPECTION FEE
($10.00)
Job Address bay W j-�
Department of Buildings
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and.hereby declares that all
the facts and representations stated in this application are true and eor - A.
Fridley, Mn.
OWNER \ 1 IL�nV�J NE rL
KIND OF BUILDING �►Z
USED AS
TO BE COMPLETED ABOUT ""rL
...ESTIMATED COST L) 2 7 O
OLD NEW BUILDING PERMIT 140. PERMIT NO.vvw 6
`i4J
Company Lo S
Signed By
Tel. No. -52 �- l
ROUGH INSP.
Date s
r•
FINAL INSP. 4 - 20 - fr I
Date ,/�
APPROVAL FOR PERMIT A d��
MINIMUM FEE FOR ANY PLUMBING PE WT Z8 87.50 PLps 8.50 STATE SQR=NR=
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
Job Address
c5
Department of Buildings
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true andcorrect
QT
Fridley, Mn. _ , 19 D o
1 .
OWNER\ I �l l W C��
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT
ESTIMATED COST X17.0
RATE TOTAL oLD NEW BUILDING PERMIT NO. � -7 D PERMIT NO.
R=%ber Fixtures x $3.00
Future Fixture OpeningX $2.00 S Company ®�
New Fixture, Old Opening x $2.00 * $ Signed By
Catch Basin x $5.00 $
Water Heater - to 99,000 BTU x $5.00 $ -�® 6_ Tel. No
100,000 BTU to 199,000 BTU x $10.00
Water Softener x $7.00
flew Ground Run Old Building x $5.00
Electric Water Heater x $5.00
GAS FITTING FEES:
1st 3 fixtures x '$3.00
Additional Fixtures x $1.00
Gas Range to 199,000 BTU x $10.00
REPAIRS & ALTERATIONS
First $100.00
each add. $100.00 or fraction
State Surcharge
TOTAL FE
REINSPECTION FEE
(S10.00)
$5.00
$2.00
S
S
$ ROUGH INSP.
$ Date
FINAL INSP. �� � /9 ` 0
$.cc, • Date
$
$ APPROVAL FOR PERMIT �(
S . •
S MINIMUM FEE FOR ANY PLMMING PERMIT Is $7.50 pLUs $,s0 sTATS 8MCW 4Z
e
>
m
a
d+
Water
d
u
' A
s
E
aa
N
4J
04
w
Heater
•.•
C7
b
C
4.j
t
k
.0 S
o d
rt
W
,O
•N
Q
+1
NA
N
O
O
S
i� N'
UI
N
N
ij
yr
U
a
M
tC
vi
c e w
rA
w
u �
a
�$
a0+
as
lec
1st
2nd
3r3
4t -,
(R) = Future Connection Opening
Connected with Sewer
(�) - New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
Job Address
c5
Department of Buildings
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true andcorrect
QT
Fridley, Mn. _ , 19 D o
1 .
OWNER\ I �l l W C��
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT
ESTIMATED COST X17.0
RATE TOTAL oLD NEW BUILDING PERMIT NO. � -7 D PERMIT NO.
R=%ber Fixtures x $3.00
Future Fixture OpeningX $2.00 S Company ®�
New Fixture, Old Opening x $2.00 * $ Signed By
Catch Basin x $5.00 $
Water Heater - to 99,000 BTU x $5.00 $ -�® 6_ Tel. No
100,000 BTU to 199,000 BTU x $10.00
Water Softener x $7.00
flew Ground Run Old Building x $5.00
Electric Water Heater x $5.00
GAS FITTING FEES:
1st 3 fixtures x '$3.00
Additional Fixtures x $1.00
Gas Range to 199,000 BTU x $10.00
REPAIRS & ALTERATIONS
First $100.00
each add. $100.00 or fraction
State Surcharge
TOTAL FE
REINSPECTION FEE
(S10.00)
$5.00
$2.00
S
S
$ ROUGH INSP.
$ Date
FINAL INSP. �� � /9 ` 0
$.cc, • Date
$
$ APPROVAL FOR PERMIT �(
S . •
S MINIMUM FEE FOR ANY PLMMING PERMIT Is $7.50 pLUs $,s0 sTATS 8MCW 4Z
'k
W4
SUBJE&
RMIT NO.
City of Fridley
3 01 1 8
AT THE TOP OF THE TWINS
BUILDING
PERMIT
i 6
NO.
—�����COMMUNITY DEVELOPMENT DIV.
I LV ,
r � � PROTECTIVE INSPECTION SEC.
1 � �
V `
---'fl CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED By
�.j
612-571-3450
910-F15
8/27/99
JOB ADDRESS
6341 Madison Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
15
6
1 Christie
SHEET
2 PROPERTY OWNER MAIL ADORES$
ZIP PHONE
Carol Newcomer
574-0297
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Panelcraft of MN 3118 Snelling Ave S Npls
MN 55406 721-662R 2179
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
0 NEW O ADDITION 0 ALTERATION ®x REPAIR 0 MOVE 0 REMOVE
8 DESCRIBE WORK
Reroof house and IZarajZe 19 S Tear -off: Reside house and arage:
Soffit Fascia and Trim
8 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with the State Building Code.
Call for building wrap inspection before covering.
Provide soffit ventilation to meet the State Building Code.
Permit inspection Cards
Will Be Malted.
To Homeowner To Post
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED,
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$12,525
$6.26
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACC ARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
223.25
F- SC $12.52
PLAN CHECK FEE
T FEE
,0/ A
Lic S 5403
2 22�ys7M
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEi
HE P VA 1 0 THIS PERMIT
�R
BOG INSP MATE
SIGNATURE OF OINNERoF OWNERSUILDERI IDATEI
W4
�
`®
NEW [ ]
Effective 1/1/98
ADDN [ ]
CITY OF FRIDLEY B®�' :30/1?
ALTER [ ]
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 � �D � � 3/ V9
BUILDING PERMIT APPLICATION
'/) 1 •r[/) X16 ✓fi��7y
�jv� NJ� o�oZ e 5-.J
ConstructionAddress:
�.s
Legal Description:
Owner Name & Address:
W/ Tel. #
Contractor: MN LICENSE #
Address: -e, Tel. #
Attach to this application, a Certificate 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:
Length Width Height Sq. Ft.
DECK AREA:
Length Width Hgt/Ground Sq. Ft.
OTHER:
S/Q%in9/So�flt �CISC��/t/h/
Construction Type: l 9�'y !'w �'� n Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: ��aQl 9 9 APPLICANT: �ctie L/z Tel. #
47
CITY USE ONLY
Permit Fee 6V3' $ Fee Schedule on Reverse Side
Fire Surcharge $ 6'.2- .001 of Permit Valuation (1/10th%)
State Surcharge $ (o $.50/$1,000 Valuation
SAC Charge $ $1000 per SAC Unit
License Surcharge $ 5,00 $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control
Park Fee
$
Sewer Main Charge $
TOTAL $ 62 a 31 S 3
STIPULATIONS:
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 65432
(763) 572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Effective On Jan 1, 2002
PLUMBING FIXTURE RATES:
NO. RATE TOTAL JOB
New Fixtures
$ 7.00
The undersigned hereby makes application for a permit for the work herein
Old Opening, New Fixture
$ 4.00
specified agreeing to do all work in strict accordance wiih the city codes
Beer Dispenser
$ 5.00
and rulings of the Building Division, and hereby declares that all the facts
Biovr Off Basin
$ 7.00
and representations stated in this application are true and correct.
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Receiving Tank
$7.004
Water Treating Appliance
$10.00
Owner ,�.11��{��%���
Water Heater -Electric
$ 7.00
Water Heater - Gas**
$10.00
Building Used As
Gas Range*`
$10.00
(�
Gas Dryer*
$10.00
Estimated Cost PERMIT NO.
Back Flow Preventer Required ( )Yes () No
Type
$15.00
PLUMBING COMPANY i—)e l��/li�5 �
Reinspection Fee $47.00/Hr
SIGNED BY TEL NO.Ur' / 7G
ALL OTHERS ANDIOR REPAIRS AND ALTERATIONS
FAX #(L� / � �
1.5% of Value of Fixture or Appliance
Approved By�. _ Rough -in Date Final Date. ()3
State Surcharge
$ 50
WN, IMM FEE FOR ANY PW SINGIQAS PERMIT IS W.00
TOTAL FEE
s �
PLUS THE 1.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC
SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
When raninGigIg an Avinting figgaM 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 venting system is plasddpVC and meets all current codes and manufacturer
specftations including sizing, length, number of elbows and termination. Yes( ) No( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the a m ent codes and manufacturees specifications. This does
indude AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes( ) No( )
The is sized and installed to meet the current codes
and manufacturer's specifications. Yes( ) No ( )
When required to r+ calla now cnimigi ijtionak.)t will be Sneed and installed
to meet the current codes and manufacturer's specifications. Yes( ) No( )
When n+�n st WK yaaWosytstem, the undersigned hereby vermes that
it is'a listed assembly and meets the current codes and manufacturer's
speafications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes( ) No( )
Is the common vents and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes () No ( }
Appliance #1 Type BTU InputFan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appltances Toth Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height k Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height R Length ft Diameter in Tye
HEATING CO.-
Signed
O:
Signed By Date:
t'0/ Z0'd V66Z989iS9 01 ATM I8A d0 Al I0 W08A £S :t°t Z00Z-SZ-adU
Commercial/Industrial
1.25% of Value of Appliance or Work
State Surcharge $ 50
TOTAL FEE $ So
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
'Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes an
rulings of the Building Division, and hereby declares that all the facts and
representations staled in this application are true and correct.
DATE����
BLAINE Iiia. AIC ELECT. INC.
HEATING CO 1—AM EKA UN -MO AVE.�.E.
Signed
Approved By
Rouglrin Date
TEL $1 Lll O�S17(lo,D
Final Date�Z
BACK SIDE MUST JBE FILLED IN ON VENT SIZE, VENT CONNECTORS I
AND COMBUST10 AIR VERIFICATION
1TY OF FRIDLEY INSPECTION DIViSION
��
��
Effective On January 1, 2001
,431 University Ave NE
ridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
'63.572.3604
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS. 3`�l r elz&� DYI S1 / uL
RATE SCHEDULE
CLrd /qz YJ0—nff
OWNER
tesidenlial
Rate
TOTAL
Furnace Shell and Duct Work, Burner •
BUILDING USED AS
Also Replacement Furnace
$ 30.00
$
J _�
(Side Vent . Fill Out Back)
ESTIMATED COST �7 PERMIT.NO.
Gas Piping (Needed with new furnace,
$ 10.00
$
.
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNt
Gas Range
$ 10.00
$
No. of Healing U fts�_ Circle One (Steam) (Hot Water) arm
o
Gas Dryer
$ 10.00
$
Trade Name Size No. L9 U
�—
BTU , HP EDR
*Air Conditioning • All Sizes
$ 25.00
$ `�.
Fuel Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK) %
(
$`b
Burner trade Name Size No.
BTU HP EDR
1°J, of Value of Appliance or Work 1i tU)
i
Commercial/Industrial
1.25% of Value of Appliance or Work
State Surcharge $ 50
TOTAL FEE $ So
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
'Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes an
rulings of the Building Division, and hereby declares that all the facts and
representations staled in this application are true and correct.
DATE����
BLAINE Iiia. AIC ELECT. INC.
HEATING CO 1—AM EKA UN -MO AVE.�.E.
Signed
Approved By
Rouglrin Date
TEL $1 Lll O�S17(lo,D
Final Date�Z
BACK SIDE MUST JBE FILLED IN ON VENT SIZE, VENT CONNECTORS I
AND COMBUST10 AIR VERIFICATION
fl Ift
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, 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. Ye4 No( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes (4 No( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA -LAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes No( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes No ( }
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes j} No( )
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA -LAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes` l I No ( )
Is the common vent and vent connectors sized and installed correctly after J
an appliance has been removed from the common vent and vented
separately as per current codes. Yes ( No ( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input �D�`ZSQZ' Fan Assisted or Nat 1 L.
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter , in Type
Appliance #2 Vent Connector Height ft Length ft Diameter ---in Type
Appliance #3 Vent Connector Height R Length ft Diameter in Type
ALTERATIONS: (Describe)
BLAINE HTG. A/C ELECT, INC.
13M CENTRAL AVE. N.E.
HEATING CO: ANOKA, fAN 55:304
Signed By: B"- Date: d
CIIYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
February 14, 2003
Ms. Carol Newcomer
6341 Madison Street NE
Fridley, MN 55432
Re: Final Inspection at 6341 Madison Street NE
Contractor: Blaine Heating AC Electric Inc
Dear Ms. Newcomer:
A mechanical permit was issued on September 14, 2001 to install a furnace and air
conditioner at your address. According to the 1991 Uniform Mechanical Code a final
inspection shall be conducted on the work authorized by this permit. As of this date the
inspection has not been requested.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. We will keep your permit open for another 30 days and if we do
not hear from you within this time to set up the inspection, we will mark the permit "no
inspection called for by homeowner after notification" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
DJ/mh
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-3604 FAX: (763)571-1287
ADDRESS
6341 MADISON ST NE
PIN
143024420101
LEGAL DESC
CHRISTIE ADDITION
LOT 15 BLOCK 6
PERMIT TYPE
HEATING
PROPERTY TYPE
RESIDENTIAL
CONSTRUCTION TYPE
FIREPLACE
VALUATION
NOTE: INSTALL GAS PIPING FOR FIREPLACE.
APPLICANT
FIRESIDE HEARTH & HOME
2700 N FAIRVIEW AVE
ROSEVILLE, MN 55113
1111.'hl2�
NEWCOMER CAROL S
6341 MADISON ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wort
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulati gt� nWuction or the performance of construction.
Bldg Insp.
PERMIT .:2004�
DATE ISSUED: 06/21/2004
HEATING PERMIT MINIMUM FEE 15.00
STATE SURCHARGE, PLBG FLAT 0.50
TOTAL 15.50
PAID WITH CHECK # 607434
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY BUILDING INSPECTION
6431 Univdrsity Ave NE
Fridley, MN 55432
763-572-3604 FAX 763-571-1287
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furna e, Fireplace, sert)
Gas Range
Gas Dryer
Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Fee Total
$35.00
$
$10.00
$
$10.00
$
$10.00
$
*Air Conditioning - All Sizes $25.00 $
All Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work $
Minimum Fee $15.00 for Residential or 5% of cost of
Improvement whichever is greater on work less than $300.00
JOB ADDRESS—& -3 q / ./M -, ,,:, I —'; �. 9 9.
Owner ®o 'r'� 4 D & r
Building Used As 4:a"de:^ t' tE'
ESTIMATED COST PERMIT NO
DESCRIPTION OF FURNACE AND BURNER
# of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name kh-g a . I e A -e' Size No.
BTU HP EDR
Fuel Total Connected Load
Burner Trade Name
BTU
HP
Size No.
EDR
The undersigned hereby makes application for a permit for the work herein
Commercial/Industrialf Institutional specified agreeing to do all work in strict accordance with the City Codes
1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts
Minimum Fee $35.00 for Commercial/IndustriaVinstitutional and representations stated in this application are true and correct.
AM Rtn WO
State Surcharge $ .50 HEATING CO &a'&home
/
9=KFaVvk wMw
/' ems'
�`
TOTAL FEE $ l � J v Sign Pm wft NUI65113
�1, Tel #
REINSPECTION FEE $50.00/HOUR FAX # Date ID i 1
*Air Conditioners can not be placed in side yard without written approval
from adjoining property owner - copy to City
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
o ree-l?-0
eo c*- . �-
,1
I�
Approved by Rough-in.Date Final Datel`C_T
:;k;2 > � �� 94 ! I CWo fl ---
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
4 ,. . , , , :.. .. , .,.A
46 COMMON VENT VENTCONNECTOR AND COMBUSTION AIR VERIFICATION
When replacina an existing furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
No( )
and is securely supported and firestopped where required. Yes ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes ( )
No ( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes ()
No ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes ()
No ( )
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes ( )
No ( )
When installinra a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category 1 Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes ( )
No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes ()
No ( )
Appliance Type 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 Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height _ Diameter inches
Appliance #1 Vent Connector Height ft Length. ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
B
� g �2
HEATING CO: K
113
Date :4-4-j
Signed By: �� �- _ _._ ,�-�®
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 FAX: (763) 571-1287
ADDRESS : 6341 MADISON ST NE
PIN : 143024420101
LEGAL DESC : CHRISTIE ADDITION
: LOT 15 BLOCK 6
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOW/DOOR REPL
PERMIT N .: 2�OOt_�01000
.
DATE ISSUED: 06/25/2004
VALUATION : $ 3,794.00
NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317
OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS. REPLACE 4
WINDOWS WITHIN EXISTING OPENINGS.
STATE LICENSED CONTRACTOR 1
APPLICANT
RMA HOME SERVICES INC
3200 COBB GALLERIA PKWY #200
ATLANTA, GA 30339 -
OWNER
DAN ALLARD
6341 MADISON ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wort
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Annlican n Date
Bldg
BUILDING PERMIT FEE 97.25
FIRE SURCHARGE 3.79
STATE SURCHARGE, VALUE 1.90
LICENSE SURCHARGE 5.00
TOTAL 107.94
PAID WITH CHECK # 35921
Permit Inspection yards
Will Be Mailed
To Homeowner To Post
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
04/02/2004 FRI 13:21 FAX ELDER JONES Q001/001
Oj. '
NEW [ ] CITY OF FRIDLEY Effective 4/1/2004
ADDN [ j 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
(763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: to -3q i1(���
Legal Description:
Owner Name & Address Y1 ��o�Cd Tel. #(Ol`oZ•�' 49
Contractor_ RMA HOME SERVICES INC.
Home Depot Installed Sales MN LICENSE #
Address: 3200 Cobb Galleria Pkwy., Ste. #200 Tel. #
Atlanta, GA 30339
763-542-8826 :ificate of Survey of the
BC -20268257 )n drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft
GARAGE AREA: Length Width Height Sq. Ft
DECK AREA: Length Width Hgt/Ground Sq. Ft
OTHER: Lk U kr"L[r'ANS t-0 I; dV ..Q
Construction Type: Estimated Cost $ r -�9 `i V
DrNeway Curb Cut Width Needed: Ft. ,. 6 Ft = Ft x $ _ $
DATE: APPLICANT: Tel. #
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 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 [ ]
STIPULATIONS:
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
571-36U4 VAX: (763) 571-1287
ADDRESS : 6341 MADISON ST NE
PIN : 143024420101
LEGAL DESC : CHRISTIE ADDITION
: LOT 15 BLOCK 6
PERMIT TYPE : ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
PERMIT NO.: 2004-01040 k ,3&9 /
DATE ISSUED: 07/06/2004
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL ONE CIRCUIT IN
BASEMENT.
# INSPECTIONS 2 # 0-100 AMP CIRCUITS 1
APPLICANT
DAN ALLARD
6341 MADISON ST NE
FRIDLEY, MN 55432
OWNER
DAN ALLARD
6341 MADISON ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp.
ELEC CIRCUIT FEE (0-100 AMPS)
0.00
ELEC PERMIT FEE - MIN (RESI)
40.00
ELECTRIC FORM FEE
1.00
STATE SURCHARGE, ELEC FLAT
0.50
TOTAL
41.50
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
571-36U4 1{AX: 1763) 571-1287
PERMIT NO=2004-01077
DATE ISSUED: 07/12/2004
ADDRESS : 6341 MADISON ST NE
PIN : 143024420101
LEGAL DESC : CHRISTIE ADDITION
: LOT 15 BLOCK 6
PERMIT TYPE : BUILDING
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE ADDITION/ALTERATION
VALUATION $ 2,500.00
NOTE: SEE NOTATIONS ON PLAN.
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS.
PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE
2000 INTERNATIONAL RESIDENTIAL CODE. BASEMENT REMODEL.
APPLICANT
DAN ALLARD
6341 MADISON ST NE
FRIDLEY, MN 55432
CULT/yI 04 �7
DAN ALLARD
6341 MADISON ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wort
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating cons ction or the performance of construction.
� IT
ADDlicanlDate
BUILDING PERMIT FEE 83.25
PLAN CHECK FEE 54.11
FIRE SURCHARGE 2.50
STATE SURCHARGE, VALUE 1.25
TOTAL 141.11
PAID WITH CHECK # 7904
I: �_ ��aa ►
D
ate2aJ��
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
NEW [J
ADDN []
ALTER [ ]
Construction Address:
CITY OF FRIDLEY
6431 University Ave NE, Fridley, MN 55432
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
' D BUILDING PERMIT APPLICATION
Effective 4/1/2004
(763) 572-3604 Bldg Ir
(763) 571-1287 Fax
Legal Description: c(
Owner Name & Address: L L 1+4 Tel. # %
Contractor. (pVknL_ MN LICENSE#
Address: Tel. #
Attach to this application, a Certificate 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: Length Width Height Sq. Ft
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: L� 11J Estimated Cost: $ (J
Driveway C b ut Width Needed: Ft + x = $ L
3,1
-7 0 �/
DATE: APPLICANT: Tell%//'�
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
CITY USE ONLY - I ��
V�
$ �J� Fee Schedule on Reverse Side
$ 65% of Permit Fee
$ .001 of Permit Valuation (1/10th%)
$ $.50/$1,000 Valuation
$ $1350 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 [ ]
TOTAL $ ��� • �` STIPULATIONS:
Y