PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N® 3888
Date: ... ..... ....
Owner ....................................... Builder C% .. ... ....��..
Address ...................................... Address ..........................................
LOCATION OF BUILDING
No. 10cV.. Street .... Part of Lot ................ '............ .
Lot .... �..... Block .. ..... .. Addition or Sub -Division ... ... ...../.�!✓�
Corner Lot ............ Imide Lot .. • • . r
�....... Setback '�P ~ Sidegard .... .... . `.............. .
DESCRIPTION OF BUILDING
TbAe Used as: ..• p Q
Front ;&.-10 Depth �?:�.� ..Height /I/1�..: �0 "Sq. Ft. /001 f Cu. Ft. dA -:7;V
Front A? `t® "'Depth �� �� H /.02 ,11 Sq. Ft. � O.Y Cu. Ft alt0:! (P
Type of Cons coon ................... F.st. Cost. 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 din compliance with all provisions of
ordinances of the city of Fridley. ��pp
In consideration of the payment of a fee of $...1..1, 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 city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. �"
Buildipg 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 itema.
V ' a
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name )� .Builder ,
Addx�:ess5.� Y'—A/l,Address. _
LOCATION OF BUILDING
No-. Street G '-`' _ /Part of Lot _
r
Lot, ,. Block Addition or .Sub. Div.
Corner Lot, Ynside Lot Set Back
.Applicant attach to this form.Certi,ficate of Survey of Lot'and proposed
building location.;
DESCRIPTION OF BUILDING
To be used as
-5P Front —3�)- Depth 5� Height
Sq, Ft.Cu..' Ft.
Front Depth Height
Sq. Ft.. Cu. Ft.
Type of, Construction, Estimated Cost
To be completed
�P
The undersigned hereby makes application for a permit for the work
1aerein specified, agreeing to do.all work in strict accordance with the
Ci, y 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 Z/ Signatures'
s _
(A Schedule of FeeCosts can be found on the Reverse/Side)
a
Application far Power Plants and Heating, Cooling,Ventilation. Refrigeration and �S
APP Air Conditioning System anDevices �'
PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU 4-7470
GRAVITY WARM AIR: RATE TOTAL Location
Furnace Shell Shell & Duct Work .......................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. IDR Steam ...... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
Each add. 320 sq. ft. IDR 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 BTU) ....................... 5.00
$ ✓/
GAS PIPING (Up to 3 Fixtures) .......................... 1.50
$
(Add 50c each over 3)
AIR CONDITIONING
$
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS TOTAL FEE
REMARKS:
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 are true and correct.
Fridley,
Owner���yt�1 195—
Kind of Building �� �E �) 195—
Used as
To be completed about
Estimated
Cost,
Old- �-New�Buildina Permit No. d O
DESCRIPTION OF WORK
BEATING or PQTM
7 PLANTS—Steam, Hot Wa , Warm Air . No
Trade Name.4 °� �j'- e' " c, Size No
Capacity Sq. Ft. EM.R� 0� m—o �J BTU H.P.
Total Connected Load Kind r Kind of
BURNER. — Trade Name Size No -
Cap I
o
Capacity Sq. Ft. EM.R BTU H.P.
RAY N. WELTER HEATING 00.
Signed 48jY — .
By MINN`APOLIS 7. MINNESOTA
11 POST IM -8-58 Business Phone No-
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City of Fridley
SUBJECT
P ,
btr
®1435
AT THE TOP OF THE TWINS
P R M
BUILDING
E
EIPT NO:
`L �_____ COMMUNITY DEVELOPMENT DIV.
r -I PROTECTIVE INSPECTION SEC.
/'--1 CITY HALL FRIDLEY 55432
L---- ,'J
NUMBER
REV.
DATE
PAGE OF APPROVED BY
612-560-3450
910-F15
9/13/77
JOB ADDRESS 980 Overton Drive N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
5
Brookview Terrace 2nd Addn. SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Ed Breitenfeldt 980 Overton Drive N.E.
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
B USE OF BUILDING
Residential
7 CLASS OF WORK
NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
�❑ X
X
8 DESCRIBE WORK
Conversion of existing arae to living area and construct a 36' x 24' detached
garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide a hard surface driveway.
WMNING
Betore digging cell foal utilities
SEIFt-O" E PERMITS REQUIRO FOR WIRING,
TELEPWONE- ELECTRIC -GAS Etc.
!{EATING. PLUMBING AND SIGNS.
REQUIRED 8Y LAW
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
wood Frame
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN BO 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
ISTALLS 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
$7,455.36
$3.72
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$34.56
PLAN CHECK FEE
TOTAL FEE
$38.28
SIG URE OFCONTR OR ORAUTHORIZED AGENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
7�^
■LIG INSP
DATE
SIGNATURE OFOWNER IIF OWNER BUILD I IDATFI•
I
CITY OF FRI,DLEY
APPLICATION FOR RESIDENTIAL BUILDING PER14ITS
(NEW, ALTERATIONS, ADDITIONS,.OR REPAIRS)
OWNER: `c( gi -Q ,,'rev /--e !,( ;� BUILDER: S' /f -,-,4
Address: 91ro 0-- Address:
Tel. No..
No.: 9 8-0 Street: 11
LOT: BLOCK: S ADDITION: 59 10
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS:
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:
G/a vsa Front: Depth: Height: �®
Square Feet: Cubic Feet:)
Depth: Height:
Square Feet: Cubic Feet:
. , S
Type of Construction: &4,d o 4 Estimated Cost: $ D 0,-0 Q
To Be Completed: Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $
(SEE REVERSE SIDE OF SHEET)
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. See reverse side for additional information.
DATE: q_ /-2 -- % % SIGNATURE:
Stipulations:
- 4j �� �(
AGREEMENT
owner of the property
located at '?4/0 Qlue4�,e7;L, have no objection to the
City allowing the construction of a to be
located at f'Ga� - ��'- E without the required
certificate of survey that the City ordinarily requires for all new
construction.
ILI
Signature
Address
—,7
7
Date
Witness
I Mrd PlailoInq 37OMisms' si/►piJUE.
I (4a&o4al7L
wr"{ ti; r�yrir� °` Minneapolis 2l,
in; „'eslrict ENGINEERING, INC. ti11nnciola
Sllnref 4 6066
Fn yineers Sur vecyon5
certilicate of suirveyI
s
y
v
'Sb
0 1 r
i !
hereby cerhiy' lhat ibis is a b-ue and correct represenfofion or-, survey Fife boundaries el'Ae oborre
/rcgfion ol'all trurldin95 , lheivon , x7doll risible encrodcbmenfs ,!f'ooy, from or ansoid /and. As surveyed me
d ;.
of " SUBURBAN ENGINEER � NO
1-ng;neers k� I �.
(Aj I rL or,'
r
SUBJECT
PE MI
City of Fridley
16 7 6 7
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
r
RECEIPT NO.
`y ______ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
r 1 PROTECTIVE
1-5-00
t'
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
1910-F15
9/16/82
JOB ADDRESS
980 Overton Drive N.E.
1 LEGAL
LOT NO.
BLOCK
RACT OR ADDITION SEE ATTACHED
DESCR.
4
5
rBrookviewTerrace 2nd SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Ed Breitenfeldt 980 Overton Drive N.E. 571-3033
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
t Gar&g.e Addition
9 CHANGE OF USE FROM TO
STIPULATIONS
A firewall is to be placed between the existing garage and the
addition.
MM FOR RME
cl 100 dots
�EPERATE PERMITS MU
41ac 601 X0 -Ec• PLUMBING AND SiG�
�i
E",0jjj, 8E-ATINGeEE
QuotED
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. 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
320
3200
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
$3,296
$1.65
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$44.50
PLAN CHECK FEE
TOTAL FEE
$46.15
GNATUR FCONTRACTO ORAUTH IZEDAGENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
D
�f` c
N
BLDG INSP f DATE
SIGNATURE OF OWNER IIF WNER BUILDER) IDATEI
r
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATI1V FOIL RESIDENTIAL BUILDIUG PERMITS
(Rew, Alterations, Additions. or Repairs)
OWNER: F -e
ADDRESS:
TEL 00: '5- 7 /— 3 0 3 -z
BUI LDER : 5
ADDRESS:
TEL 110:
Construction Location
. STRICT NO: q STREET:(� !� 0) -A P, L)
LOT: "� BLOCK: 1=1) ADDITION:
eC ee- 0•eJ F) .
Corner Lot: Inside Lot: Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
/n,_ DESCRIPTION OF CONSTRUCTION
1� Abb o Front: Ja
Square Feet: -30- Q
Depth: / O Height: /6
Cubic Feet: Jabo
Front: Depth: Nei
Square Feet: Cubic Feet:
;ht:
Type of Construction: Estimated Costa $ 0 Q -
7b Be Mrapleted: / a
Alt. A Alt. B
Proposed Driveway width If New Opening Is Desired: $ ' $
SEE REVERSE SIDE OF SHEET
'Mie undersigned hereby makes application for a permit for the »ork herein specified,
agreeing to do,all work in strict accordance with the City of Fridley Ordinances and
rulings of the Deplrtment of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE: SIGNMIE:
Stipulations:
.''.; �rt,� � ��r��r/ � � S10d1ssrss!Pf%SINE.
Alwnealv!l� W.
ENGINEERING, INC.
Enyincer-5 Sur veyor6
ciemtificate of surve
9
1,1n.5 is a f ue arid ewre-n7i -epre5rnl,-tion c bwn;birres "file abope
v�yedf �,/ foe
el.V�VXhmeW5 'eml. fmo W M;d !i7rd. A
d'7q5, , lheiror, apdOd MQ or
A. 0 ll_
SUB U28" LcNC7
[1,q;ne
. . . . . . . . . . . . .
01
SUBJECT
City of Fridley
('U21475
AT THE TOP OF THE TWINS
?
BUILDING PERMIT
B
UV
COMMUNITY DEVELOPMENT DIV.
-REzGPIF5;6:::�
_
~ PROTECTIVE INSPECTION SEC.
_ ,
CITY HALL FRIDLEY 55432
NUMBER
REV
PAGE OF
APPROVED BY
612-571-3450
910-F15
[DATE
8/3/92
JOB ADDRESS 980 Overton Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
4
5
Brookview Terrace 2nd SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Ed Breitenfeldt 980 Overton Drive NE 571-3033
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
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
❑ NEW �7 ADDITION ❑ ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
bzNKxX 1KXX Reroof Dwelling (18 Squares) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$954,00
$.5o
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIO S O ANY OTHER STATE OR LOCAL LAW REGULATING CON -
$25+00
Fire SC $.95 .
TR R H ERFORMANC F O TRUCTION.
PLAN CHECK FEE
TOTAL FEE
$26.45
SIGNATURE OFCONTRACTOR ORA ORIZEDAGENT IDATEIWHE
PR ERLY VAL ATED THIS IS YOUR PERMIT
g_g-
BLDG )NSP DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
01
NEW [ ] Effective 3/1192
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: Cl " v �� m `�
Legal Description:
Owner Name & Address:
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
-e ; ICL -
Tel. #
MN LICENSE #
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Corner Lot [ ] Inside Lot j J Ft. Yd Setback
Type of Construction:
Approx. Completion Date:
Driveway Curb Cut Width Needed:
APPLICANT: Tel. #
DATE: JIXT— ( -�
Ft. + b Ft =
Side Yard Setbacks
Estimated Cost: $ -�16-7-1 `r6
(Cost on Back)
Ft x $ = $
Permit Fee $ oo
Fire Surcharge $ . ��-
State Surcharge $ C�
SAC Charge $
License Surcharge $
Driveway Escrow $
Park Fee $
Sewer Main Charge $
TOTAL
STIPULATIONS:
RIMMWIRWIM"
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$700 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary ( )
3uilding
$
BUILDING
Permit No.:
inspections
$ q
RESIDENTIAL APPLICATION
Received By:
763-572-3604
$
CITY OF FRIDLEY
Date Rec'd:
)ATE 3Z
YOUR E-MAIL ADDRESS
Erosion Control
;ITE ADDRESSr,
,
$
HIS APPLICANT IS:
DOWNER ❑CONTRACTOR
Total Due
PROPERTY OWNER/
Nom; r,
ADDRESS: 0oz)PITY oG
STATER S✓Z
TENANT
PHONE: ✓� �%f C3 ��
CONTRACTOR
NAME;
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE—ZIP—
TATEZIPWITH
WITHAPPLICATION
PHONE FAX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILYINEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS
❑ BASEMENT FINISH XROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
Q NEW ❑ ADDITION
DWAINTEN.ANCE/REPAIR, ❑ REMODELING
DESCRIBE WORK BEING DONE: ®UC' >° C
SIZE OF Rv PRO
LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFINGt HOUSE ONLY
NUMBER OF SQU ❑ 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:
❑ Aluminum
❑ Trim
I. Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project
2. Two sets of construction plans
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:
(USINGTHE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ e5 � , OCCUPANCY TYPE
Permit Fee
$
Plan Review
$
Fire Surcharge
$ q
Surcharge
$ I. aZ
License Surcharge
$
SAC Charge
$
Curb Cut Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge
$
Total Due
$ a, CM
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)
$1550 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 payable to: City of Fridley Attach
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 for a permit 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 wor ich requires revi w and approval of plans. __ `` i�
SIGNATURE OF APPLIC7 PRINT NAME�yJ elU�f �� Xtf �zy-ATE