PRE 2010 DOCSFrame
etion Date
5-21-71,
se
Res.
10.00
Plumbing Fixture Rates: NO. RATE TOTAL
Number Fixtures x $2.00_
Future Fixtures x $1.50
New Fixture -Old Open. x $1.50
Catch Basin x $3.25
Water Heater -99,000 BTU x $3.00
Ground Run Old Bldg. x $3.25
Elec. Water Heater x $2.00
Gas Fitting Fees:
1st 3 Fixtures x $2.00
e_
Additional Fixtures x $ .75
Gas Range -199,000 BTU x $5.00
Repairs & Alterations
Description: Install Gas Grill See
Code 5.00
State Surcharge "A" Surc�-iargee ,50s, .50
TOTAL FEE $ 5.50
The undersigned hereby makes application for a permit
Eor the work herein specified' agreeing to do all work
Ln strict accordance with the City Ordinances and ruling
)f the Department of Buildings, and hereby declare that
ill'the facts and representations stated in this
application are true and correct.
'Signature re R l WGAS-70 Date
53-&-s-915.51
lq
City of Fridley "u"EGT
AT THE TOP OP THE TWINE
r
PLUMBING PERMIT T
APPLICATION
tu-------- COMMOITY DEVELOPMENT MV,
1 PR0TECTIVR QN* tCT*M 0!►T,
CITY HALL FOUDL4V 000$
41$-6"-8460 HUMO11
R$V. DATE
PAGE OF
A OV D BY
0 12/15/73
1 1
800
Job Address
360 N. E. Rice Creek
Terrace
ner
Address
Phone
Willis A. Redepenning
Contractor L-' SCO 732 f�A[�. 3:
�; p. h;Q fess
Phone
Frame
etion Date
5-21-71,
se
Res.
10.00
Plumbing Fixture Rates: NO. RATE TOTAL
Number Fixtures x $2.00_
Future Fixtures x $1.50
New Fixture -Old Open. x $1.50
Catch Basin x $3.25
Water Heater -99,000 BTU x $3.00
Ground Run Old Bldg. x $3.25
Elec. Water Heater x $2.00
Gas Fitting Fees:
1st 3 Fixtures x $2.00
e_
Additional Fixtures x $ .75
Gas Range -199,000 BTU x $5.00
Repairs & Alterations
Description: Install Gas Grill See
Code 5.00
State Surcharge "A" Surc�-iargee ,50s, .50
TOTAL FEE $ 5.50
The undersigned hereby makes application for a permit
Eor the work herein specified' agreeing to do all work
Ln strict accordance with the City Ordinances and ruling
)f the Department of Buildings, and hereby declare that
ill'the facts and representations stated in this
application are true and correct.
'Signature re R l WGAS-70 Date
From the desk of
NASIM QURESHI MEMORANDUM JF - 274
CITY MANAGER'S OFFICE
UAit: May 10 1985 TO ACTIO! INFO
SUBJECT: John Flora, DPW 5/1677,
TREE CUT AT A STONE HOUSE ON SOUTH SIDE
OF RICE CREEK, WEST OF ART SWENSON'S
On the south side of Rice Creek,,west of Art Swenson's, there is a stone house.
I received a complaint that at this house they cut a tree last year along the
creek and it seems to have died due to Dutch Elm Disease. The tree material is
still lying on the property.
Can we do something to get it removed?
Thank you for your assistance.
NMQ/ms
CC: Chuck Boudreau
To: Nasim Qureshi, City Manager
Date: May 14, 1985
Mr. Swenson, resident of 361 Rice Creek Terrace, his-"3ors, Chester Lindsey of
347 Rice Creek Terrace and Thomas Kaufhold of 3,75 Rice'Creek Terrace, were visited
on both May 13th and 14th, 1985. No branches were observed laying around.
JGF/mh
PUBLIC WORKS
MAINTENANCE MEMORANDUM
UIYOF
FRIDLEY
DATE Mav 14. 1985
FROM Ralph Volkman
TO
ACTION
INFO
SUBJECT Tree cut at a stone house on
south side of Rice Creek, west
of Art Swenson's
John Flora DPW
s
X
Nasim Qureshi CM
'
X
I have checked the properties south of Art Swensons and did not find
any large amounts of tree branches laying around.
Also, this is private property so we do not have any control and do
not have a program on Dutch Elm trees. We only go out on calls in
a advisory capacity.
RV/ta
sueJECr
PERMIT
City of Fridley
�2 7 8 g 7
AT THE TOP OF THE TWINS
BUILDING PERMIT
ECEIPT
1
v______ COMMUNITY DEVELOPMENT DIV.
r 1 PROTECTIVE INSPECTION SEC.
I CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
L J�j 612-571-3450
910-F15
9/21/98
JOB ADDRESS 360 Rice Creek Terrace
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
3
Rice Creek Plat 3
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Willis Redepenning
571-4261
3 CONTRACTORMAIL ADDRESS ZIP
PHONE LICENSE NO
Twin City Exteriors Co 9060 Zachary Ln N #108 Maple Grove 55369
425-4737 2595
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO,
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION [2 REPAIR
0 MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside
9 CHANGE OF USE FROM TO
STIPULATIONS
Call for building wrap inspection before covering.
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
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
$4,000.00
$2.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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-
$87.25
FiAe SC $4.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE//
TOTA FEE
License 5.00
$98.25
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEt
NP OPE 11A IOAT
HIS I P
_MIT
SIGNATURE OF OwNER,IF OWNER SUILOERI IDATEI
BLD SP 01gAtE
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: Q3
Legal Description:
Owner Name & Address:
Contract
Address:
Effective 1/1/97
��1qR?
P4�
1 Re-"
Tel. # -5 7/-4,��
ENSE #,���-`
Tel. # #A 541'73_
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: 9� l Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
/a7
DATE: — — APPLICANT: Tel. #
TOTAL $ �,
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ Fee Schedule on Reverse Side
Fire Surcharge
$_
.001 of Permit Valuation (1/10th%)
State Surcharge
$_, ®�
$.50/$1,000 Valuation
SAC Charge
$
$950 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
•$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer. Main Charge
$
Agreement Necessary [) Not Necessary [ ]
TOTAL $ �,
STIPULATIONS:
CITY OF FRIDLEY PERMIT ,'O.: 2004-00 4
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED:
04/21/2004,,
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 360 RICE CREEK TER NE
PIN : 143024240056
LEGAL DESC : RICE CREEK TERRACE PLAT 3
: LOT 1 BLOCK 3
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A
REPLACE FURNACE
VALUE OF APPL OR WORK 0 # FURNACES
1
# GAS DRYERS 0 # GAS RANGES
0
APPLICANT
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
0.00
35.00
ACTION HEATING & AC
8140 ARTHUR ST NW
GAS RANGE FEE
0.00
SPRING LAKE PARK, MN 55432
GAS DRYER FEE
0.00
(763) 780-0844
HEATING REPAIRS/ALTERATIONS
0.00
STATE SURCHARGE, MECH FLAT
0.50
TOTAL
PAID WITH CHECK # 8069
35.50
OWNER
REDEPENNING WILLIS A & C J
360 RICE CREEK TER 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 work
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 oj any other state or local law
regulating construction or the p ormance of construction.
Applicant Da
Bldg Ins
SEPARATE PE S QUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY BUILDING INSPECTION Effective 4/1/2004
6431"University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
763-572-3604 FAX 763-571-1287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
*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
JOB ADDRESS 3Cn Eg_<_ t p_e�_Ct c T%•
RATE SCHEDULE
Fee
Total
Z✓,i%� �������
Residential
Owner
Furnace Shell and Duct Work, Burner &
_
�5 �'J
4,5 c"
also Replacement Furnace
$35.00
$
Building Used As
Gas Piping (New Furnace, Fireplace, Insert)
$10.00
$
ESTIMATED COST7� • Gem PERMIT NO
Gas Range
$10.00
$
DESCRIPTION OF FURNACE AND BURNER
Gas Dryer
$10.00
$
# of Heating Units__1_ Circle One (Steam) (Hot Water) Larmr)
Trade Name to A1? 1tV_ Size No.
*Air Conditioning - AllSizes
$25.00
$
BTU % HP EDR
Fuel 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/industrial/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/Industrial/Institutional
and representations stated in this application are true and correct.
State Surcharge
$
HEATING CO kv? � h2::$, 0-na/ ALI
26 T
TOTAL FEE
$
-
gned Tel #
Signed
REINSPECTION FEE $50.00/HOUR
FAX # dib �✓ - 7 9 Q -? `5Date'
*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 required. Yes (V 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
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
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 (y
/
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 k
/
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
—rx-""c e --
Appliance #1 Type BTU Input iS Fan Assisted or Nat
Appliance #2 Type BTU Input 5 Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances _� Total Btu Input 11/,
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
Signed By:
,-r- e /J --
Date: Zl- - �� ^�
CITY OF FRIDLEY PERM No.: 2004-01 0
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 08/24/2004
r63) 572-3604 FAX: (763) 571-1287
ADDRESS : 360 RICE CREEK TER NE
PIN : 143024240056
LEGAL DESC : RICE CREEK TERRACE PLAT 3
: LOT 1 BLOCK 3
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIREPLACE
VALUATION
NOTE: INSTALL A GAS FIREPLACE.
APPLICANT GAS PIPING FEE 15.00
RIVER CITY SHEET METAL INC STATE SURCHARGE, MECH FLAT 0.50
9929 BLUEBIRD ST NW TOTAL 15.50
COON RAPIDS, MN 55433 PAID WITH CHECK # 13618
(763)754-2199
A/_LL
REDEPENNING WILLIS A & C J
360 RICE CREEK TER 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 perfo ce of construction.
Applicant ate
Bldg
SEPARATE PERMITS REOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY BUILDING INSPECTION
g 6431 University Ave NE
Fridley, MN 55432
763-572-3604 FAX 763-571-1287
ti RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Freql[aae, Insert)
Gas Range h eY /c_
0
~ Gas Dryer
e I�4/0770
Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
EM IQW
$35.00 $
$10.00 $-U o
$10.00 $
$10.00 $
*Air Conditioning -All Sizes $25.00 $
AQ Other Repairs or Alterations (Ust on Sack)
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 $500.00
o CommerciaVIndustriaVlnstituti nal
1.25% of Value of Appliance or Work (List on Back) $ l S. CYO
Minimum Fee $35.00 for CommerciayindustriaVinstitutiorral
U
JOBADDRESS 3b® ler Of"Jc_ Ta _ A -F
Owner
Building Used As lujal
ESTIMATED COST . ®O W PERMIT NO
# of Heating Units Circle One (Steam) (Hot Water) {Warm Air)
Trade Name Size No.
BTU HP MR
Fuel Total Connected load
Burner Trade Name
BTU _
HP
Size No.
__._ EDR
The undersigned hereby makes application for a permit for the work herein
speclf7ed agreeing to do all work in strict accordance with the City Codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
State Surcharge $ +5_0
HEATING CO Ra oex 0 e L Sker Mi
TOTAL FEE$ lam"
Signed
Tell --7&3 /7Sy --A
N
REINSPECTION FEE $50.00/HOUR
FAX # �&3 s% Qq0 Date
3 `�
*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
ti
Approved by Rough -in Date
Final Date i
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furnacethe 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 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 specifications. This does
Include AGA-GAMA Category I Central Fumac a Venting Tables for fan
assisted and natural draft appliances.
Yes ()
No
The exiistina combustion air is sized and installed to meet the current codes
and manufacturers specifications.
Yes ()
No( )
When required to install a new combustion air, it will be sized and Installed
to meet the current cods and manufacturers specifications.
Yes ()
No ( }
When installina a new venting systemthe undersigned hereby verges that
it is a listed assembly and meets the current codes and manufacturers
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 odes.
Yes ()
No ( }
Appliance Type and Slze/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 Tctal 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:
fi§IVL - ,Xi
Building
BUILDING
Permit No.oc
Received By:
Inspections
RESIDENTIAL APPLICATION
_
763-572-3604
CITY OF FRIDLEY
D'MAR 0 5 2009
DATE yJ�� 0/
YOUR E-MAIL ADDRESS WY506TNaA e_
'� is C • —
3
�� I -(- o f Ck U
_(00
SITE ADDRESS
j t G�
THIS APPLICANT IS:
❑ ❑CONTRACTOR
PROPERTY OWNER/
��OWNER
NAME: W): Wi S
TENANT
n CITY
ADDRESS:
STATE ZIP
rr ,w
-1 `J "' 3(k S
PHONE lL
NAME: Renewal By Andersen
CONTRACTOR
SUBMIT A COPY OF
STATE LICENSE Ii1920 County Road "C" West
_
YOUR STATE LICENSE
ADDRESS: Roseville, N 55113 t
M
STATE ZIP
WITH APPLICATION
PHONE License #20130983
❑ SINGLE FAMILY/NEI 651-264-4777
PROPERTY TYPE
❑ TWO FAMILY/NEW G —-------�� --
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ DRAIN TILE
PERMIT TYPE
❑ BASEMENT FINISH ❑ ROOF
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR 13 REMODELING
/y
DESCRIBE WORK BEING DONE: -Fe ( LCE (.A > CX�S � "� �'�/ `` � c -
y
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHTSO- FV
ROOFING
❑ HOUSE ONLY
REMODELING SUBMIT
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
B
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
❑ Vinyl
❑ Aluminum
❑Soffit
❑ Trim
ADDITIONS
1.
& PORCHES SUBMIT
Site Plan/Survey showing the existing structure
❑ 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
♦ TT1fi � i Cr.
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST yr I.ABOR tura i.IAL 1 RUAL17:
(USINGHE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 3, 06? 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
$ . I CQ
$ . 'Sa
$ 5j 0z
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 Attae
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
conformance with the ordinances d codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not
permit but only an application fo permit and work is not to start without a permit; that the work will be in accordance with the approve
plan in the case of all work whic Imo' es revi w'jind approval of plans. I'll 1 /An , 1 A C)
SIGNATURE OF APPLICANT