PRE 2010 DOCSVillage of Fridley, Minn.
BUILDING PERMIT N° 1750 '
Date: ...... d2-.. ........... ........
Owner....................................... Builder ..... ....... .......
Address...................................... Address ..... / ......... ...
LOCATION OF BUILDING
No.. ..�7... Street .. .. ... .......................... Part of Lot .......
Lot .............. Block .... ............ Addition or Sub -Division .. ..... .. .
Corner Lot ........... Inside Lot ..... Setback .. 1:7.4... Sideyard ........
DESCRIPTION OF BUILDING
To be Used a
10. ........ .... Front ,..6 .% Depth Height .... S. Sq. Ft. ........ Cu. Ft. ........
Front ........ Depth ........ Height ..... Sq. Ft. ........ Cu. Ft. ........
®®®
Type of Construction ...... Est. Cost ../....-- ... To 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 village of Fridley.
.6ii-
.........................
In consideration of the payment of a fee of $. �!'�'....., permit is hereby granted to'
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 regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
............ .
.Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
City of Fridley, -Minn.
BUR DING PERMIT N® 3878
Date: ........................................
Owner ............... .......... ...... Builder
Address...................................... Address..............�..............................
nn LOCATION OF BUILDING
No. 0/5. /'�7 Street ..� ... Part of ........ ...................
Lot ......... Block ... / ............. Addition or Sub -Division �'Z ..... z
Corner Lot ............ Inside Lot............. Setback ............ Sideyard ...... ....................
DESCRIPTION OF BUILDING
o be U ed as:
VA
y (A s. l y p, .,
J �N
A .. .�.... Front /. .. Depth ...... Height A. . Sq. Ft. -1 .4? Cu. Ft..
.................... Front ........Depth ........ Height ........ Sq. Ft......... Cu. Ft. ........
Type of Construction ................ Est. Cost. 10,615To be Completed ...................
In consideration of the 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 provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $. Y �-. permit Is hereby granted to ...................
......................... 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 an 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
on violation of any of provisions of said
ordinances.
• �,7%'i�!/% Building Inspector
NOTICE:
This permit does not cover the construction, installiftion or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Item&
APPLICATION FOR BUILDING PERMIT
;..,r CITY OF FRIDLEY, MINNESOTA
Owners NameeZ✓ lrr Builder
Address 'ls �7fiP �,� Address
LOCATION OF BUILDING
Nov Street _ _ _ —.Part of Lot
Lot 11�L Block Addition or Sub. Div. ��r✓ o�� .
Corner .Lot... Inside Lot _ Set Back
Applicant attach to this form Certificate'of Survey of Lot and proposed
build mg- location.
DESCRIPTION OF BUILDING
To be used as91
.
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth height
Sq. Ft. out ��Ft.
Type of Construction "'7,'1J2� Estimated Cost%�
To be completed �, � %�! SJ7
The undersigned hereby makes.appli.cation 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
are true and correct -,--
Date `?='L� . %�g Signature P
(A Schedule of Fee Costs can be found on the Reverse Side)
is
City of Fridley, Miura. N° 7791
BUILDING PERMIT 36 y V
Date: June 9s 1965
owner: Donald Holum Builder McCall and Cog
Address 6,575 Monroe Street N. E. Address 1618 West Lake Street
LOCATION OF BUILDING
Na 6575 Street Monroe Street N. Be* ____ Part of Lot
Lot 2 _ Block 1 Addition or Sub -Division Clover Leaf, 2nd Add.
Corner Lot _ Inside Lot
Sewer Elevation
To be Used as:
Setback Sideyard
Foundation Elevation
DESCRIPTION OF BUILDING
Front Depth Height Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Fast. cost 830,09-0_QC To be Completed
Storm damage rePair
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 fort, ani compliance with 21 provisions of
ordinance of the city of Fridley.
In consideration of the payment of a fee of 10.00 , permit is hereby granted to Macau & Co.
Todd Alexander to construct the building or addition as described above. This permit is granted upon
the:xpress conditionkand
personin,around and d buildridley,Minnesota rlti
thin the citylimits
ordinances.
Allen Jensen Building Inspector
NOTICE
Uh perms dos WO truer the eonslMCOM, hatallation for Whin& t+hunhi+e, an hadno, ewer or Wder. Be sure to M
the Butldloa hopester for separate pranks for thea items.
Vi
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'SNAME. cs�}" ��� BUILDER
ADDRESS 43"7S --
ADDRESS OA/ fl=)
LOCATION OF'BUILDING
No. Street Part of Lot,
LOT BLOCK I :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 Coat -1
To bre- completed
The-tindersipned herdby.makes appligation 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 e,?ewe SIGNATURE E-, " 41�i C14-
(Schedule
1r
(Schedule of Fee Costs can be found on the Reverse Side).
1 f 4
M
Or -6
City of Fridley, Mian.. N° 1059
BUILDING PERMIT
Date: April 2, 1970
Owner: Donald Holum Builder — Same
Address 6575 Monroe Street N E Address Same
LOCATION OF BUILDING
No. 6575 _ Street Monroe Street N.E. _ part of Lot
Lot 2 _ Block 5 — Addition or Sub -Division Clover Lea £ ecand__A d d i t-1 on
Corner Lot Inside Lot _._. X Setback — Sideyard
Sewer Elevation — Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Addition to Housq cont 221 Depth 16 ` Height 10, Sq. Ft 2' Cu. Ft 01
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Frame Est Cost 000 _ __ To be Completed ZunP 1 , 1970
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. LOU � -
In consideration of the payment of a fee of $ 25.00 , permit is hereby granted to Donald Holum
to construct the building or addition as described above. This permit is granted upon
the express condition that theperson 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 andmoving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Building Inspector
NOTICE:
Hilt permit does not cover the construction, instalFaHoe for whiny, plumbing, gas hosting, aver or water. Be aura to we
the Building Witeeter for Separate parmilts for thea Mems.
!p/0,<A e.o , ,
Phone: GRcenwood 3-8352
A RLEIGH. C: -SMITH
Registered Professional Engineer and Land Surveyor
2030 East 'Wayzata Boulevard Wayzata, Minnesota
PLAN' OF SURVEY
OFPROPERTYOF� '�C�c n �, fY o t_ a .� s 6 S 7S
described as follows: — —� �.1_ _'T:5-93 Z
�-6C� Rti—� E A F' S E �- O ^•1 D --- D D � T/ o N _-- _--
Scale: 1 inch_' 20 feet.
('J
2,V: z
zz.z
i
-- - - 7 7.O
r
I I
f _
'L
GR RACE T� Pi E" ; W
NovCZ' ;Q A 4'F"Q L To d
w rpF A4 U ITN JU
i J
5
`f:9 /D.T ,
-as az /2_�/ IC—D
CERTIFICATE OF LOCATION OF BUILDING ; CERTIFICATE OF SURVEY
I hereby certify thatend F'�s 19,7E 1 I hereby certify th =
made a survey of thecLaa=z; location of the building surveyed the proper•t,, �,' =erihed above and that the
on the above described property and that the location above plat is n correct r presenta'-tion of said survey.
of said building is correctly /shown on the above plat.
-.,
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S . NAME • Da .4L o //a L u,01 BUILDER:
ADDRESS •� S H ADDRESS:
NO:. STREET:
LOT; o BLOCK: ADDITION: z` .� �rQ:/•
CORNER LOT: INSIDE LOT:_L:::::::� SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
Front: a a Depth: 14 Height: /d
Square Feet: Cubic Feet: 3 o'
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: Estimated Cost:
To Be Completed:
The undersigned hereby makes app scat a for a permit for the work herein
specified, agreeing to do all work in sttict 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: <j_ — Ja SIGNATURE : 7'-�
(See Reverse Side For Additional Information.)
CITY OF FI %LEY INSPECTION DIV.
NE
Effective On January 1, 1991
fi431 University Ave
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
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
'Air Conditioning - All Sizes
OtherslRepairs & Alterations (LIST ON BACK)
of Value of Appliance or Work
, Commercial/Industrial �„ m-
i
I% of Value of Appliance or Work � �¢
State Surcharge 1-50
JOB ADDRESS n ®�
The undersigned hereby makes application for a permit for the work
Rate TOTAL herein specified agreeing to do all work in strict accordance with the
city codes and ruling of the Building Division, and hereby declares
S20.00 $ that all the facts and representations stated in this application are
true and correct. -% r- + Q _.1991
$ 10.00 $
OWNER
$ 10.00 $
BUILDING USED AS
$ 1000 $ ESTIMATED CO �. PERMIT NO.
$10.00
S
y.e DESCRIPTION OF FURNACE AND OR BURNER
$ 3 ®. 00 No. of Heating Units Circle One (Stearn) (Hot Water) (Warm Air)
Trade Name Size No.
STU HP EDR
$ Fuel Total Connected Load
TOTAL FEE $ : ®, S` -O
MINIMUM FEE FOR ANY HEATINGICOOLINGfVENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
i
PLUS THE $.50 STATE SURCHARGE
' REINSPECTION FEE $30.00
•Air Conditioners can not be placed in a side yard without
written permission from adjoining property. owner.
Burner Trade Name Size No.
BTU HP. EDR
HEATING COMPANY_ =Y L \ ,�" � A '
Na
Signed By)„In c�+� � ►-�'` "�o s a�.Tel No.
ApproY;:d Fy� IS._ `! _- Rough -in Date Final Date -giL--'3
FILL OUT BACKSIDE FOR STACK VERIFIC,"TION ON
REPLACEMENT FURNACE
SUBJECT
City of Fridley
29299
AT THE TOP OF THE TWINS
BUILDING
P E R M I T
r
-
RECEIPT NO.
• _____ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
�
r � PROTECTIVE
L "'>;•� CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APVROVED By
---.�
L 612-571-3450
910415
4/26/99
JOB ADDRESS 6575 Monroe Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
1
1 Clover Leaf 2nd
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Holum 6575 Monroe Street NE
571-9042
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Pennington Construction 4347 Central Ave NE, Columbia Heights, MN 55421
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
788-4889 20169391
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION CR REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Garage; Soffit & Fascia
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building
Code. Install
soffit ventilation to meet the State Building Code
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday
thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
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
1
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
$1.71
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$3,428
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
ANY OTHER STATE OR LOCAL LAW REGULATING CON-
PEs
$ $7.25
Fire SC $3.43
SHE PER RMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTALFEE
$92.39
F ON" ACTOR ORA iZED AGENT IDATEI
WHEN PROPER. I.ID TED THIS IS'YOUR PERMIT
�lliP�Y
— `7 /
OW NER,IF OWNER BUILDER. IDATEI
A, ngr v
I OAtE
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Effective 1/1/99
Owner Name & Address: Tel: #�� %l
Contractor: P,, MN LICENSE
Address:�� 7-�� Tel. #��
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
,OTHER:
Construction
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Grround
�V c A �:7'/ZX 7J
.Driveway Curb Cut`Width N
Sq. Ft.
Sq. Ft.
Sq. Ft.
Khnated Cost: $
(Fee Schedule on Back)
e . Ft. + 6 Ft = Ft x $ _ $
DATE: "1 APPLICANT: ! �� �s� % — Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee $
Sewer Main Charge $
TOTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 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 [ ]
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
e:,
ell
Effective On January 1, 2000
Residential Rate
TOTAL
a
_ t Wor, Burner -
Furnace-S.hell and Duct —Fu
Als�eplacement
BUILDING USED AS
Furnace - $ 30.00
(Side Vent - Fill Out Back)
$�
ESTIMATED COST �� `� � ' PERMIT NO.
Gas Piping (Needed with new furnace, $ 10.00
$
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNER
Gas Range $ 10.00
$
No. of Heating Units �® Circle One (Steam) ftt Water) arm Air
Gas Dryer $ 10.00
$
Trade Name �_N�I� F Z_ Size No.'--WWP36-IL---
BTU Q Cwt �, HP EDR
*Air Conditioning - All Sizes $ 25.00
$
Fuel MA W DC Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK)
Burner Trade Name Size No.
1% of Value of Appliance or Work
$
BTU HP EDR
Commercial/Industrial
1.25/0 of Value of Appliance or Work
$
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
State Surcharge
$ .50
rulings of the Building Division, and hereby declares that all the facts and
o
representations stated in this application are true and correct.
TOTAL FEE
$-
tiEM€2 E INDOOR AIRM
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
2(3t9 COON RAPIDS BOULEVARD lo(NA73_c '
HEATING CO L(0 ICA41 �
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
rvliq 550t55
COON RA '"
(:' ��' __7!5
PLUS THE $.50 STATE SURCHARGE
Signed -�-_ _ - TEL #
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
Approved BYA Rough -In Date Final Date
written permission from adjoining property owner.
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
Appliance #2 Type
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 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
Diameter inches
and meets the current codes and manufacturer's specifications. This does
Appliance #1 Vent Connector Height
Appliance #2 Vent Connector Height
Appliance #3 Vent Connector Height
include AGA-GAMA Category I Central Furnace Venting Tables for fan
t
�'�� ft
ft
ft
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 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-GAMA Category I 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 #11 ype BTU Input t �� ° ssisted br 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
Appliance #2 Vent Connector Height
Appliance #3 Vent Connector Height
ft Length
ft Length
ft Length
t
�'�� ft
ft
ft
Diameter 4 in Type
Diameter in Type
Diameter in Type
ALTERATIONS: (Describe)
HEATING CO: DEPENDABLE INDOOR AIR QUALITY,. II111
b
eig COON RAMS SOMEVARD
Signed By: 200H, RAPIDS. MM X55433 Date:
-C)
Building
$$
BUILDING
Plan Review
Permit No.
Inspections
Fire Surcharge
RESIDENTIAL APPLICATION
Received By:
763-572-3604
$
.0005 x Permit Valuation Minimum $.50
DateU A P 8 Z��
$ "5, oo
$5.00 (State Licensed Residential Contractors)
CITY OF FRIDLEY
$
:
DATE YOUR E-MAIL ADDRESS
$
SITE ADDRESS S 7�
Erosion Control
THIS APPLICANT IS:
❑ OWNER KONTRACTOR
Park Fee
PROPERTY OWNER/
NAME: 2'r\
Sewer Main Charge
TENANT
ADDRESS: 6 S-7 5
CITY —c—y STATE 42P
$ q a, -L7D
PHONE:_ 3 Z 1 ^ 4?O4 Z—
CONTRACTOR
NAME: A el -e pa ler
STATE LICENSE # EXP DATE
^ A/'
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: 3630 /•53 -
CITY ®r -l— STATIkIP�S3
WITH APPLICATION
PHONE G ) 2 -5 - 3ca - q ,6 FAX '763 - 7/1-1
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION
SIZE
❑ TWO FAMILY/NEW CONSTRUCTION
STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED
❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF
❑ DRAIN TILE
❑ DECKSIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ,12WMODELING
DESCRIBE WORK BEING DONE: • e ,3t
SIZE OF IMPROVEMENT L NGTH
WIDTH HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1. Existing Floor Plan
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Altmtin
❑ Trim
1. Site Plan/Survey showing the existing strictures
❑
❑ Fascia
and proposed project
WINDOWS
2. Two sets of construction plans
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
3. Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ o,N2a "0 OCCUPANCY TYPE
Permit Fee
$$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$ "5, oo
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1675 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = R x $21 =$
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$ q a, -L7D
Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
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 and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application foraermit 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 w . es r v w and approval of plans. J/
SIGNATURE OF APPLICANT PRINT NAME !/V ` ` =l�'l �1R4� DATE 16—