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PRE 2010 DOCSCity ®f Fridley, Mm. , ► / LQCAT OF ILDING Nora,t._ Street P Lot Lot Addition or Sub -Division f&- , Corner Lot , Inside Lot Setback .—_ Sideyard -- C - Sewer Elevation _... Foundation Elevation DESCRIPTION OF BUILDING To Used . R Front � —� 10 Depth Height �� Sc!• Ft. FL—2-1- Depth Height _ _ Sq. Ft. Cu. Ft. Type of Construction Est. Coat __ 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 ;h provisions of ordinances of the city of Fridley. . A J /J a n ^ 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 within the city limits and this permit may be revoked at any time upon violatio y of the provisions of said ordinances. ®"°+. I Y7 NOTICE: This permit don not corer the construction, installation for wiring, plumbing, an boding, sower or water. Be sore to we the Building Inspector for separate permits for there items. OWNER °S APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA ADDRESS ADDRESS No. LOCATION OF BUILDING Street Part of Lot Lot Block 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 build- ing location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as: Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction_ Estimated Cost 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` SZGNATI1ItE (Sebedule of Fee Costs can be found on the Reverse Side). V x y , 0. Application for Power Plants and Heating. Coaling, Ventilation. Refrigeration and 4/ Air Conditioning Systems and Devices • PARTIAL RATE SCHEDULE DepL of Bldgs. Phone SII 4-7470 GRAVITY WARM AIR: RATE Furnace 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 MECIL WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 each add. 80,000 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 840 sq. ft. IDR Hot Water ... 8.00 Each add. 200 sq. ft. EDR Steam ...................... 2.50 Each add. $20 sq. ft. EDR Hot Water .................. 2.50 TOTAL $ $ $ OIL BURNER to 3 gal. per hour ........................ 5.00 $ over 3 gaL per hour—See Fee Schedule GAS BURNER (up to 400,000 BTL)) ....................... 5.00 $ GAS PIPING (Up to 3 Fixtures) .......................... 1.50 $ (Add 50c each over 3) AIR CONDITIONING FAN DATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS REMAR=t $ See Fee Schedule $ TOTAL FEE a 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, Minn MAY 14 1963 , 195 Owner 195 Kind of BuRdAg 195 Used as To be completed Zut J U L 141963 Estimated Cost, $ New. uilding Permit No. DESCRIPTION OF WORK HEATING , Warm Air—No� Trade Name Size No Capacity Sq. Ft. E.D li � �'-�% • BTU H.P. Total Connected Loa �� �/� �-� Kind of Fuel G� t BURNER — Trade me-- Size No Capadty Sq. Ft. TU H.P. AMG IRING & i�IR COND. CO. o' , /a 6409 GOODRICH AVE. S. .vj' � MINNEAPOLIS 26, MINN. S 929-8538 $y 11 POST IM -8-58 Business Phon No 1 otal 13tu.1 1 41 Required sq. ft. E.D.R. or Isq. ins. W.A. Leader area Fl -1 Room I Length I. 3 Width Height Windows and Doors--P—rackage and Area Width Height No. o[ Lineal ft. Area No. of pane of pane lights of crack sq. ftp. Jv �wP�q d Coef.I Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor C;a P Total Btu. Required sq. ft. E.D.R. or ''sq. ins. W.A. Leader area 00 I Fl.1 ,jVRoom l Lenstth ®/ Width 'V Heistht - 'I I I ICoef.1 Btu Infiltration 1 %/A . Glass Exp. wall e Net exp. wall Int. wall Ceiling Floor.-- Total loor.9 °` Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area `/ — Fl.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. tt. -( 11 Infiltration 6_ II __ Glass Exp. wall of pane I!iglhte of crack eq. ft. Net exp. wall Int. wall Width Height No. of Lineal ft. Area No. of pane of pane lights of crack SQ. ft. oi Coef. Btu Infiltration HEAT LOSS CALCULATIONS DEPARTMENT OFA BUILDINGS MINNEAPOLIS. MINN. Weatherstrips A.S.H.V.E, Glass Construction No. Insulation Net exp. wall Int. wall Guide keference 19_ Ceiling Windows Doors 1--Te—s—No Out. Wall Int. Wall Ceiling Roof Floor 1 Kind How Applied Yes—No 11 FI.j / f Room' Length Width Height Fl.� Room Length Width Height Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. ofpane Width Heighi No. of Lineal ft. Area No. of Wane of pane tight. " of crack sq. ft. 1 otal 13tu.1 1 41 Required sq. ft. E.D.R. or Isq. ins. W.A. Leader area Fl -1 Room I Length I. 3 Width Height Windows and Doors--P—rackage and Area Width Height No. o[ Lineal ft. Area No. of pane of pane lights of crack sq. ftp. Jv �wP�q d Coef.I Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor C;a P Total Btu. Required sq. ft. E.D.R. or ''sq. ins. W.A. Leader area 00 I Fl.1 ,jVRoom l Lenstth ®/ Width 'V Heistht - 'I I I ICoef.1 Btu Infiltration 1 %/A . Glass Exp. wall e Net exp. wall Int. wall Ceiling Floor.-- Total loor.9 °` Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area `/ — Fl.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. tt. -( 11 Infiltration 6_ II __ Glass Exp. wall of pane I!iglhte of crack eq. ft. Net exp. wall Int. wall Width Height No. of Lineal ft. Area No. of pane of pane lights of crack SQ. ft. oi Coef. Btu Infiltration Coef. Btu Infiltration ' *77 ,Fr Glass Ceiling Net exp. wall Int. wall Exp. wall 410 , ,k Ceiling Net exp. wall Int. wall Ceiling 1 otal 13tu.1 1 41 Required sq. ft. E.D.R. or Isq. ins. W.A. Leader area Fl -1 Room I Length I. 3 Width Height Windows and Doors--P—rackage and Area Width Height No. o[ Lineal ft. Area No. of pane of pane lights of crack sq. ftp. Jv �wP�q d Coef.I Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor C;a P Total Btu. Required sq. ft. E.D.R. or ''sq. ins. W.A. Leader area 00 I Fl.1 ,jVRoom l Lenstth ®/ Width 'V Heistht - 'I I I ICoef.1 Btu Infiltration 1 %/A . Glass Exp. wall e Net exp. wall Int. wall Ceiling Floor.-- Total loor.9 °` Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area `/ — Fl.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. tt. -( 11 Infiltration 6_ II __ Glass Windows and Doors-Crackage and Area Exp. wall Width Height No. of Lineal ft. Area No. of pane of pane e of crack sq. ft. 1Mght Net exp. wall Int. wall Width Height No. of Lineal ft. Area No. of pane of pane lights of crack SQ. ft. Ceiling Floor Total Btu. Windows and Doors-Crackage and Area ...bus Width Height No. of Lineal ft. Area No. of pane of pane e of crack sq. ft. 1Mght Width Height No. of Lineal ft. Area No. of pane of pane lights of crack SQ. ft. lej Coef. Btu Infiltration Coef. Btu Infiltration Glass Glass *77 Exp. wall Ceiling Net exp. wall Int. wall Floor Ceiling Floor Total Btu. Required sq. ft. E.D.R. or'sq. ins. W.A. Leader area ER&M Kequired sq. tt. LIM. or sq. ins. W.A. Leader area if A r" I .--° — - — n 1 r .1 k --o 99l_ _].L 0'tl_•_t_. etaO i 1.1 awju Amov"A 1 L..ca.jsku ,....... " ...bus Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack SQ. ft. lej Coef. Btu Infiltration Glass IR' Exp. wall Net exp. wall �+ Int. wall Ceiling Floor Total Btu." Required sq. ft. E.D.1k. or sq. ins. W.A. Leader area City of Fridley Application for Plumbing and Gas Fitting Permit DESCRIPTION OF WORK Number, Kind and Location of Fixtures q Id � �P � � �� Z� o� � Q <t "K �c _G ~? tai S� a3 �s t�°d ay z t7� �a t�0 F N WATER HTR. GAS ELEG Base New Ground Run Old Bldg. ............ x 3.25 $ : I 1st t 4 t 2nd 3rd _ 4th • Future Connection Openings * New Fixture, Old Openings Connected with Sewer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL f ��, Number Fixtures .................... x $1.50 $ Future Fixture Opening ................ x 1.20 y� $Tf New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg. ............ x 3.25 $ GAS FITTING FEES: NO. RATE 1st 3 Fixtures .......................... x $1.50 Additional Fixtures x .50 Gas Range to 200,000 BTU .............. REPAIRS & ALTERATIONS—Refer to Code x 2.00 TOTAL $ $ Dept. of Bldgs. Phone SU 4-7470 City of Fridley: 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 fact and representations stated in this ajAcation are ®true and correct. FrjAley, /1 19 ZQ 64f Owner C Kind of Used as To be completed about Estimated Cast, $ Old—New. Building Permit No Permit No. '—>— Signed— By Business Phone No S ROUGH FINAL Description ................................................$ TOTAL FEE $ 4 % aZ 2M SUBJECT PER NQ City of Fridley 220 AT THE TOP OF THE TWINS BUILDING PE MIT i RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. ~ PROTECTIVE INSPECTION SEC. NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 9/9/93 JOB ADDRESS 5531 Regis Trail NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 2 Parkview Oaks 1st Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ronald Morin 5531 Regis Trail NE 571.0638 . 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO, Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 6 DESCRIBE WORK Construct a 20k x 13191k Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notab.Qns on plan.. WARN11 Before digging call for all utility locaon� RFQtjIREDo�� 8Y LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. 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 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS I 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 $2 8Q0 $l. 40 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 PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $54.00 ,Fire SC $2..80 STRLICTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $58,.20 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHP4 P VALIDATED THIS IS YOUR PERMIT 4KOG SR CZ DATE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: 6- 3 Legal Description: Owner Name & Address: Contractor: Effective 5/26/93 *3 43 Tel. # 57J O f MN LICENSE # Tel. # Attach to this application, a Certificate of Survey of the K with the proposed construction drawn on it to scale. DESCRIPTION OF IIAPROVEMENT LIVING AREA: Length . Width Height Sq. Ft. GARAGE AREA: Length DECK AREA: Length 2P Width � Width TF Height Hgt/Ground `Z"' -Sq. Sq. Ft. Ft. Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Type of Construction: C.& ® 010 Approx. Completion Date: _ CI Side Yard Setbacks Estimated Cost. $ (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft.= Ft x $ _ $ DATE: -7 Pkf APPLICANT: Tel. #Ez—aae Permit Fee $ SV DO Fire Surcharge $ �O State Surcharge $ SAC Charge $ License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ 56 ` 2Q— Fee Q Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $750 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Conservation Plan Review $450.00 Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] STIPULATIONS: INDUSTRIAL BUSINESS C'TY LOTS TOPOGRAPHIC MAPPING C. E. COULTER PLATTING LAND SURVEYOR FARM s�RVEys LAKESHORE REGISTERED UNDER LAWS OF STATE OF MINNESOTA Ju DICIAL LICENSED By ORMNANCES OF CITY OF MINNEAPOLIS 3300 LYNDAL_E AVE 50 MINNEAPOLIS 8, MINN TAYLOR 4-0370 *urbepor'.o Certificate fw m :1: D;p C"i,'.1. u'1. {: le ceI:, )vo �� _ e •...,;i CI:-.. eoG3 _ OL' a SL_'JL;" of i�(�, 1. 7 ^� �-'C'�. .� _.._u.1 � ... 1..—. ..� F.._.. _� .__�. �.. 1TI-.�� '-i'ali��'. �• �1..i1 .��+7 _.:..11:ZE�.•: l�li'. } 0 r ,_ _. =�'� - __!;GSI `• . � �-�� _ .__,�. �nn0:_c Building BUILDING Permit No.:C�® d t O Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: DATE 7 ' O YOUR E-MAIL ADDRESS SITE ADDRESS C, . THIS APPLICANT IS: ❑ OWNER 11�_ONTRACTOR PROPERTY OWNER/ NAME: Al M041 -��/ ADDRESS: I /K�r L p CITY OC Q�%� STATF�ZT TENANT PHONE: -763 —5-7f 0 G3 CONTRACTOR NAME: STATE LICENSE # ar®/ ®(e q I DEXP DATE ! SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: l 000lq !& & O � t S® CITY �fcl�ro v� STATEN ZIP WITH APPLICATION PH NE e V2® a FAX PROPERTY TYPE ff SINGLE FAMILYINEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHEDOWS 11 BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: /YIQN t SIZE OF IMPROVEMENT LENGTH 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: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ 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 $ ' C) OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Surcharge $ ® (.0005) times the total job valuation — Minimum $.50 Fire Surcharge $ 1, 9,S7 .001 x Permit Valuation (1/10%) License Surcharge $ e^ „� $5.00 (State Licensed Residential Contractors) SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ a 5— 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 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 work whiphe uires review and approval of plans. �r SIGNATURE OF APPLICANT PRINT NAME �s C ��j�1�P DATE 6J ^�0- 9 -0-C Building BUILDING Permit No.:VG��� Inspections RESIDENTIAL APPLICATI®N Received By: a 763-572-3604 CITY OF FRIDLEY Date MAY O 763-502-4977 FAX EFFECTIVE 1-1-08 DATE 1;3—YOUR on E-MAIL ADDRESS SITE AD KESS %S 7/ AI L THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: lnor,v ADDRESS: CITY STATE—ZIP— TATEZIPPHONE: TENANT PHONE: NAME: ADDRESS: (J ®®® o �� doc So CITY d STA �iP _�73 % CONTRACTOR SUBMIT A COPY OF r/ PHONE ln1 /2 03 9- FAX YOUR STATE LICENSE STATE LICENSE # EXP DATE PROPERTY TYPE INGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ 9ARAGEISHED ❑ WINDOWS ❑ BASEMENT FINISHOOF ❑ DRAIN TILE ❑ DECK ❑SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ N W HOME CONSTRUCTION ❑ ADDITION AINTENA/N'')CE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: Pe !G Q O/ SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES 4gle ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used. PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ADDITIONS. & PORCHES SUBMIT: ❑ Vinyl ❑Soffit 1. Site Plan/Survey showing the existing structures ❑ Aluminum ❑ Trim t. and proposed project ❑ Other ❑ Fascia 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 AREXASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: TOTAL JOB VALUATION $ eEe �� SINGd 997 UBC FEE SCHEDULE)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 $ cV.`7S $ /, $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1825 per SAC Unit (Plans to MWCC for determination) -ft +6 ft= 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 ackn ledge t 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 Minneso Co s cti n Codes; that I understand this is not a permit but onIan application for a permit and work is not to start without a permit on site; that the work will be in acco an e approved plan in the case of all work which requires vi w and approval of plans. SIGNATURE OF APPLICANT PRINT NAME 0 1f -DATE,!; -13-0? APPROVED BY DATE