PRE 2010 DOCSNEW ii CITY OF FRIDLEY Et 40WO 1A4002
ADQN I j 6431 Univsty Ave NF- F,d47y. MN 88432 (763) fn4e04 Bid$ insp
ALTER (j SINGLO FAINLY AND DUPLEXES R 1 AND R-2
SUB-CONTI A -Ad OR -IST
Address
77 ' pej•mlt'1k
General Contractor Meadow. Vi6W ,Home-; .Ind} Jeffrey 'L. trniz
Wner;.
'Plumbing Contractor „ . • '
•Rdb 'Garin, Pliunbing; Ines .
•Heating Contractor.
.G' anical, Inc.
'Sower/Septic Contractor
Casper * --s, Excavating;' .Inp.
*Water Contractor
Casper -I's Ekcayating, Ih ./R•.A..''Aacvlover 'Constniction
Fireplace Contractor
. Coddor'Firepj6ace and Stone'
Lawn Sprinkler Contractor.
r1/A•'
*Swimming Pool'Contractor
Excavating Contractor
Casper•'s Fx9avating, Inc.A.A,.• MacGlover Constniction
Masonry Contractor
J.z,' H' Lsonry,. •.Inc:'
_. ..—,_..
Insulation Contractor
Nordic Iniiilation.; Inc:
Blacktop Contractor
I '-'Lakes Blacktop,
Stucco Contractor
Roof Contractor
E erio'rs bylie
`Separate permits orb required,
NOTE: ALL contractors must be,licensed'and insured..
CITY OF FRIDLEY BUILDING INSPECTION0or
Effective 4/1/2004
6431 University Ave NE
Fridley, MN 55432
APPLICATION FOR POWER PLANTS AND. HEATING, COOLING, VENTILATION
763-572-3604 FAX 763-5711287
REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
']'PIU% "
JOB ADDRESS �o I-)
o RATE SCHEDULE
Fee Total
Residential
Owner
Fumace Shall and Duct Work, Burner &
$35.00 $
a,
Building Used A J41fn -I'a L_
also Replacement Fumace
.�
Gas Piping (New Fumace, Fireplace, Insert)
$10.00 $
ESTIMATED COST Z0 aOt_. Cf— PERMIT NO
Gas Range
$10.00 $
DESCRIPTION OF FURNACE AND BURNER
Gas Dryer
$10.00 $
# of Heating Units_ Circle One (Steam) (Hot iter Wa
o
Trade Name cau Cir Size No.
*Air Conditioning - AllSizes
$25.00 $ ��0
BTU VO, CCO HP EDR
Fuel A�%r�� Total Connected Load
All Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work
$
Burner Trade Name Size No.
Minimum Fee $15.00 for Residential or 5% of cost of
BTU HP EDR
Improvement whichever is greater
The undersigned hereby makes application for a permit for the work herein
Commercial/Industria/Institutional
specified agreeing to do all work in strict accordance with the City Codes
1.26%0 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.
State Surcharge
$ J C
HEATING CO j MQ f 6(0:La C'
TOTAL FEE
$ o
Sign Tel #74a - 7Cp�
REINSPECTION FEE $50.00/HOUR
FAX # - LO Date
*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
Approved by Rough -in Date Final Date
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT:. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where reqs fired. Yes () No( )
The venting system is plastic/PVC and meets all current (odes and manufacturer
specifications including -sizing, length, number of elbows, nd termination.
Yes () No( )
The undersigned also verifies that the replacement unit is a listed assembly
BTU Input Fan Assisted or Nat
and meets the current codes and manufacturer's specific- .tions. This does
BTU Input Fan Assisted or Nat
include AGA-GAMA Category I Central Furnace Venting T ibles for fan
Total Btu Input
assisted and natural draft appliances.
Yes () No ( )
The existing combustion air is sized and installed ,to mE et 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 specificatic is.
Yes O No ( )
When Installing a new venting system, the undersigned hereby verifies that
it is alisted assembly and meets the current codes and m nufacturer's
specifications. This does include AGA-GAMA Category I ventral Furnace
Venting Tables for fan assisted and natural draft appliancE s.
Yes O 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)
HEATING CO:
Signed By: Date :
Building
BUILDING
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd:
DATE
YOUR E-MAIL ADDRESS �~
SITE ADDR1 S E
i` le (�e P k o�
THIS APPLICANT IS:
OWNER ;XONTRACTOR
PROPERTY OWNER/
NAME: 4Ptt`L w V ; e4L 144, ej
1 ``
ADDRESS: I Y (r,.Z / d eY- A e e +A &4 • M F CITY f4y w, L, Kr
STATE%AEIP�G
TENANT
PHONE: 7S-_.? •- %S 7' —/J% it
CONTRACTOR
NAME:�cA g L,� � ; e I,, J jg y--i e j
SUBMIT A COPY OF
STATE LICENSE # b]� - u��t % C EXP DATE 3 Z �'O
31�
55
YOUR STATE LICENSE
ADDRESS: I ( J\ b n � -r r r� S h V C _ _ _ _ _ _ _CITY lit
m L,rX e STATL ZIP 3 C7 y
WITH APPLICATION
PHONE � 7X01 -- 79 7-73LB FAX 67 --:Z-57- Y1 I
PROPERTY TYPESINGLE
FAMILYINEW CONSTRUCTION SIZE
•
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
•❑ ADDITION ❑ GARAGUS-HED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING OTHER
❑ SWIMMING POOL
TYPE OF WORK:NEW
❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: CyE}s r v�P c•+. �i 'C 'J a
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT 3 Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
2•
Existing Floor Plan
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 exisd✓r g structures
11 Other
El Fascia
and proposed project
WINDOWS
2.
Two sets of construction plans v'
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:
87 (USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ i� 70� O OCCUPANCY TYPE
Permit Fee $ ' i -7a-7 < 25 See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Surcharge $ (.0005) times the total job valuation — Minimum $.50
Fire Surcharge $ .001 x Permit Valuation (1/10%)
License Surcharge $ $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 $ Make checks pavable to: Citv of Fridlev 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 whic equires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME 1 r If �iL,� r DATE
Building
UATIO
, INCLUDING THE COST OF LABOR
BUILDING
a 3® S'�F
Permit Ivo.: 1
Inspections
1997
RESIDENTIAL
APPLICATION
Received By:
763-572-3604
OCCUPANCY TYPE
CITY
OF FRIDLEY
Date Rec'd:
DATE jd ��
See Back Page for Fee Schedule
OUR E-MAIL ADDRESS
$
SITE ADDRE S G
i C' (�t'r' F
tK
Surcharge
THIS APPLICANT IS:
OWNER PqONTRACTOR
(.0005) times the total job valuation — Minimum $.50
PROPERTY OWNER/
NAME: l
t v � e -j
.
ADDRESS: Y�
i +
r'r' ` + S•f lu F CPPV t7G1►Z I—..t' STATE%4IP Sicd/
TENANT
151
PHONE: 7(�•—
- L
SAC Charge
CONTRACTOR
NAME:
k
$1450 per SAC Unit (Plans to MWCC for determination)
SUBMIT A COPY OF
STATE LICENSE #
EXP DATE 3
YOUR STATE LICENSE
ADDRESS: I
t° e r S i�:
f— _ CITY I-,ytrs t.ii,9 STATE
WITH APPLICATION
PHONE 6 3 -- 75 `7-
3 L'0 FAX '761
-- 7S- 7- S%
PROPERTY TYPE
SINGLE FAMIXIEW C NSTRUCTION
SIZE �%�•
Fee Determined by Engineering
❑ TWO FAMILY/NEW CON TRUCTION
STORIES
PERMIT TYPE
❑ ADDITION
❑ GARAGE/SHED
❑ WINDOWS
$ 1
❑ BASEMENT FINISH
❑ ROOF
❑ DRAIN THE
❑ DECK
❑ SIDING
OTHER
❑ SVAN49 NG POOL
TYPE OF WORK:
W
❑ ADDITION
❑ MAINTENANCE(REPAIR
❑ REMODELING
DESCRIBE WORK BEING DONE:
e-� •f w r "
•m:; O 'o'
SIZE OF IMPROVEMENT
LENGTH
WIDTH HEIGHT ��3 U Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HC USE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ AT
FACHED GARAGE
1. Existing Floor Plan
2. Proposed floor plan
PROPOSED SIZE:
❑ DE
rACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
[]Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Triri
1
1. Site Plan/Survey showing the exists g structures
❑ Other
13Fas is
and proposed project
WINDOWS
2. Two sets of construction plans j,-
/IN
INEXISTING OPENINGS ❑Yes ❑No LOCATION
DF WINDOWS
3. Energy Calculations 41-11
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF
14UMBER OF WINDOWS
ASL FEES ARE BASED
NON
UATIO
, INCLUDING THE COST OF LABOR
AND MATERIALS:
a 3® S'�F
SING
1997
U.B.0 FEE SCHEDULE)
TOTAL JOB VAL
ON $ r
,- 0
OCCUPANCY TYPE
Permit Fee
$
! '7
See Back Page for Fee Schedule
Plan Review
$
'1/ 000
•Z E3
65% of Building Permit Fee
Surcharge
$
115--'
(.0005) times the total job valuation — Minimum $.50
Fire Surcharge
$
so,—S
.
.001 x Permit Valuation (1/10%)
License Surcharge
$
151
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
1-159 .
k
$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 ')FVEIP,N' fwt BB
$
/ 5-00,
®
Fee Determined by Engineering
Sewer Main Charge tll
$
Agreement necessary ( ) Non Necessary ( )
Total Due I-Ai8 � 60
$ 1
l l oqcl .
(
Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APP
I hereby apply for a building permit and I ackn
conformance with the ordinances and codes of the
permit but only an application for a permit and w,
plan in the case of all work whicbAequires review
SIGNATURE OF APPLICANT
axoo."S- /2
FOR A PERMIT -NOT VALID UNTIL PROCESSED
edge that the information above is complete and accurate; that the work will be in
y of Fridley and with the Minnesota Construction Codes; that I understand this is not a
is not to start without a permit; that the work will be in accordance with the approved
approval of plans.
7 >
PRINT NAMI:i �winrL? G y e DATE
�' / O -
City of Fridley
6431 University Ave. NE
Fridley, MN 554324383
763-571-3450
25-Au&05 Special Assessment
Search And Statement of Charges
TO:
On all that tract or parcel of land lying and being
in Anoka County, Minnesota described as follows to wit:
Parcel No: 13-30-24-44-0115
Lot: 1, Block: 1, TI-1EILMANN EST
LEVIED
SPECIAL ASSESSMENTS
This is to certify that I have examined the records
in the office of the Clerk, City of Fridley, Anoka County, Minnesota, and for
such search, certify that the following special assessments
appear unpaid with respect to the above described tract or parcel of
land:
Term Certified Initial Interest Remaining Current Current
Proiect Number Project Descri tion Type
(Yrs) Date Amount Rate Balance Princi al Interest
NONE
PENDO
G SPECIAL ASSESSMENTS
For the purposes of this document, the City of
Fridley has determined that an assessment is considered pending after the City
Council passes a resolution ordering the improvement,
the approval of plans and the advertising for bids. This is prior to the
City Council adopting the final assessment rot.
If you seek further information, you should do so upon your own independent
inquiry. Any amount given as to pending assessments
is informational only and may or may not be the amount ultimately
assessed.
Term Initial Interest Estimated
Proiect Number Proiect Description(Yrs)
Year Rate Pending Amt.
ments 0 2004 0.000% $4,978.86
5000-2004-01 00 Theilmann Estates Improv
$4,978.86
MIS
ELLANEOUS FEES
Descri tion
Status Date Fee Amt.
Park Fees
Unpaid 3/24/2003 $1,500.00
UTILITY CHARGES
You shall be responsible to verif
r the status of any outstanding utility charges. To check utility charges
( water and sewer) contact
Fridley Utility Billing Department at 763-572-3529.
The records referred to above are public an
I may be inspected by anyone during regular business hours. The search of these
records was made by the undersigned as a p
jbfic service on request. The undersigned certifies that the above indicated
searches were made and are believed to be accurate,
however, the undersigned or the City of Fridley does not insure the
accuracy of the above statements and does not
assume liability for errors and/or omissions.
The above figures are good through November
15, 20
Date Prepared: Thursday, August 25, 2005
By
Page 1 of 1
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
PLUMBING
Permit No.:�
Building
Inspections
RESIDENTIAL
APPLICATION
Received By:
763-572-3604
CITY
OF FRIDLEY
Date Rec'd:
DATE /� �S S
YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS: 0 OWNER MCDNTRACTOR
PROPERTY
NAME: A ov CIN!"
h6we :
ADDRESS:
CITY STATE ZIP
OWNER/
TENANT
PHONE:
CONTRACTOR
NAME: 04 <;-Zr'
freerr�,�
STATE LICENSE # ®z,
' /
EXP DATE
`/f ` CITY �n�sJ�•® STATO ZIP_Sr_S �
SUBMIT A COPY OF
YOUR STATE
ADDRESS: e277t'
LICENSE WITH
PHONE 67 /1- 69;F-
/10 FAX
APPLICATION
PERMIT TYPE
0 SINGLE FAMILY 13
TWO FAMILY 0 TOWNHOUSE
TYPE OF WORK:
® NEW
0 REPLACEMENT
DETAILED DESCRIPTION OF WORK
w e-
PER MS 1613.665 the permit fee is a minimum of
15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor)
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES AKE
BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
S BATH SINKILAV / FLOOR DRAINS
}� o /
7– SHOWER WATER PIPING
� BATHTUB 7;i F GAS PIPING
crrrcicerA _ SWIMMING POOL —WATER SOFTNER ($35)
/ CLOTHES WASHER KITCHEN SINKWATER
LAUNDRY
CLOSET BACKFLOW PREV. ($15)
Y / WATER HEATER ($35) FOR IRRIGATION
I DISHWASHER /
T WATER METER —OTHER
.,
Permit Fee $
0Number of fixtures @ $10.00 x $10.00 = $
� Number of fixtures @ $15.00 x $15.00 $
Surcharge .50
TOTAL DUE $
_
e
1 ,� Number of fixtures @ $35.00 x $35.00 = $
'� y" State Surcharge = $ .50
"J Total = $
THIS IS AN AppLI
CAT.16N' 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 end
work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of a rk which requir
s review and approval of plans-
PRINT NAME �%� r/k DATE //' ✓
SIGNATURE OF APPLICANT Of
Citi F�.���'
Y
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
,PC -)O 61--s CC r__1Ki
City of Fridley
6431 University Ave NE
Fridley MN 55432
(763) 572-3602 or Fax (763).502-4977 �j Cr�,P2CatB
.-Water and Sewer Permit Application
New Connection
❑ Existing
Date: I-7�3- b(0
❑Utility Line Repair/Relocation
❑Water and Sewer Connection
Job Address: 1
Name of Applicant (Plumber): VL o � vrc,
Name of Property Owner: c6 LA -),J,. -C k z, VV" -L 'I-,
Existing Structure Permit
Permit Type: Sewer Fee:
Water Feer
Meter Fee:
Repair Fee:
Relocation:
State Surcharge: -b x Z e A 8®
SAC Charge:
Special Assessment Fee:
Total: $ /��/
Applicant Signature
Inspector approval:
Water Meter Repair – Weekend & Holidays
$125/hour
Water Connections Permit
$50
Sewer Connections Permit
$50
hispection Fee for Water/Sewer Line Repair
$40
Special Assessments
See Engineering
Cost of Water Meter
See Utility Billing
SAC Charge
$1550
State Surcharge
$ .50
Water Tap
See Engineering
04/04/05
dn
Building
$
BUILDING
Plan Review
Permit No.:
Inspections
Surcharge
RESIDENTIAL APPLICATION
(.0005) times the total job valuation — Minimum $.50
Received By:
763-572-3604
.001 x Permit Valuation (1/10%)
CITY OF FRIDLEY
$
Date Rec'd: �L
DATE 8 ® =0
YOUR E-MAIL ADDRESS
$1450 per SAC Unit (Plans to MWCC for determination)
SITE ADDRESS l -S- Y Z R 1 C_ F_ F_ k K L A
$
THIS APPLICANT IS:
❑ OWNER ONTRACTOR
$
PROPERTY OWNER/
NAME: IV! & A D Q, w V I E W I'1 f,
$
TENANT
ADDRESS:I `IC-:- 1 ems" [)&P N XT CITY AAm L. 0,K f—
p�
STATBI'I, �IP
Agreement necessary ( ) Non Necessary ( )
PHONE: �'C3 —
$
CONTRACTOR
NAME: S A VA L A-5 A P V
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
HONE FAX
PROPERTY TYPE
MINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
2.
Existing Floor Plan
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.
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 $ 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
$
.001 x Permit Valuation (1/10%)
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = a ftx $20 = $ q Li -Q
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
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 which re es review and approval of plans. l
SIGNATURE OF APPLICANT RINT NAME A V � �L 14 V 14 L ) W DATE r I