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PRE 2010 DOCSCity City of Fridley, Minn. WELDING PERMIT N9 Date: Owner: At, <--IBuilder Address Address 1LOC6;RONi0?j BUILDING No. 14 Part of Lot Lot Block Addition or Sub -Division —_ t Comer Lot Inside Lot Setback 4r2/ . Sideyard ?, o Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING Front Depth Height Sq. Cu. Ft ? Depth Height2q 4Ft. Cu. Ft.,� 2= I& of Construction Est. Cost 40�C be Completed In consideration of the Issuance to me of permit to construct the building described above, I agree to do description thework In accordance with the n 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 permit Is hereby granted to...._.. toconstruct 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 within the city limits and this permit may be revoked at any time upon. violatio# of any of the provisions of said ordinances. I In . I Building. Inspector Ile NOTICE: This permit does not cover the construction, Installation for wiring,,plumbing, L gas beating, sewer or water. Be sure to see the Building Inspector for separate permits for then hems. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner's Name,.,[➢AI& P 56 h ky AR J Builder Address �,d Address LOCATION OF BUILDING 111�7 No. Streets= Part of Lot Lot l Bloek / Addition or Subdivisioa;��L� Corner Lot Inside LotSetback, j j—.. Side -Yard /�e� .�%✓y� SEWER ELEVATION . FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and.proposed building location. DESCRIPTION OF BUILDING To be,\ used as: _ i Front_- Depth 6 Height --- 'le Sq. Ft. �� Cu. Ft. ® Front,® Depth Height. 0. 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 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. SIGNATURE (A Schedule of Fee Costs can be found on the Reverse Side.) APPLICATION FOR HEATING OR POWER PLANT AND SPECIAL DEVICE PERMIT PARTIAL RATE SCHEDULE GRAVITY WARM AIR: Furnace Shell & Duct Work ......................... Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 ................ Repairs & Alterations each add. $500.00 ............... MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ........... each add. 60,000 BTU ........................ Replacement of Furnace ............................ Repairs & Alterations—up to .$500.00 ................. Repairs & Alterations each add. $500.00 .............. STEAM or HOT WATER SYSTEM RATE TOTAL 8.00 $ 4.00 $ 4.00 $ 2.00 $ _ 8.00 $ 1, ® 0 1.00 $ 4.00 $ 4.00 $ 2.00 $ Furnace Shell & Loins—to 400 sq. ft. EDR Steam ...... 8.00 $ _ 'Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ .Each add. 200 sq. ft. EDR Steam ....................:. 2.00 $ wEach add. 320 sq. ft. EDR Hot Water .................. 2.00 $ OIL BURNER. --to 3 gal. per hour ........................ 4.00 $ over 3 gal. per hours—See Fee Schedule _ GAS BURNER .................. , ....................... ®O GAS PIPING (Up to 5 Fixtures) .......................... 1 AIR CONDITIONING FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ TOTAL FEE $ REMARKS: 11 'Dept. of Bldgs. Phone nomm T ___L__ ev1,, 5— lff,"2, _ _ The undersigned hereby makes application for a pe t for the work herein specified, agreeing to do all work in strict accordance with the Village 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. Owner Kind of Building Used as To be completed about 1955, 195- 195— Estimated Cost, $ lg 0 0 Old -S Building Permit No. S,� DESCRIPTION OF WORK A�- HEATING or POWER PLANTS—Steam, Hot Water, Warm o Trade Nam Size o Capacity Sq. Ft. E.D.R 10 ' H. P. Total Connected Load41 — Kind of Fue BURNER — Trade Name _— Size No— ___ Capacity Sq. Ft. E.D.R BTU H. P. Sign By. 1 1 2M-5-58 Business Phone No ���� D•56 79 tJ!LbER, .,. c TP -hl-, 1e F-1ooG F,e-iDL-". • { HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS, MILAN. Weatherstrips A.S.H.V.E, Construction No. Insulation Guide Windows Doors Reference Out. Wall Int. Wall Ceiling I RoofKind How. Applied s—No Ye YeI s—No 19 FFloor 0 Fl.l � , a Room I Lenlrth-xd," Widthid' ", Height fi ° a `1 II 9 Fl.l V. A. ^ Room I Length 91;o" Width 9 o°" Heightg so "1 Windows and Doors—Crackage and Area ),-a Height g �o ' Width Hetght No. of Lineal ft. Area No. ofpane of pane lfghts of crack sq. ft. Width Height No. of Lineal ft. Area No. of Dane of pane lights of crack sq. ft. I') -v Qq. Z— 14. 5 Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Coef. Btu Infiltration 77.0 5 9 29;Z S - Glass .0 42 7a Glass�,l� Exp. wall :50 X01 =®m Net exp. wall Net exp. wall 0-2 1760- 6®.Int. Int.wall Net exp. wall 2i i so Ceiling 5 7 Int. wall Ceilings Floor Floors ,p, a , &„ R Total Btu. A/ VO Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 11-a A F1.I Width 1 i'®ra " HeightV ®`' Windows and Doors—Crackage and Area ),-a Height g �o ' Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of Dane of pane lights of crack sq. ft. I') -v Qq. Z— 14. 5 Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Coef. Coef. Btu Infiltration 33.8 6 .0 42 7a Glass�,l� ,o :50 X01 20. Exp. wall Net exp. wall Net exp. wall 9C Net exp. wall 2i i so Y,.0" 1 5 7 Int. wall Ceilings Floor 6 7,. ,p, a , Ceiling Floor p �; `,� Total Btu. ° � Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I k Fl.1 ® 1 t41 Room I Length � 3 6 Width I ),-a Height g �o ' Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of®pane lights ofcracksq. ft. 13 7-4. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Coef. Coef. Coef. Btu Infiltration 6 59 42 7a Glass ,o :50 X01 Exp. wall Exp. wall Net exp. wall Net exp. wall 9C 9, 2i Int. wall Ceiling Int. wall Ceilings Floor 6 7,. ,p, a , Total Btu. ft. E.D.R. or s4, ins. W.A. Leader area Windows and Doors—Crackage and Area --- Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of®pane lights ofcracksq. ft. 13 7-4. Coef. Btu Infiltration Coef. Coef. Btu Infiltration /5, 3 Net exp. wall -� 7 Int. wall Glass Ceiling Zf X01 76. Exp. wall Net exp. wall Net exp. wall, Ceiling Int. wall Floor Ceiling Floor 4a ., Total Btu. / 9� 1 R.l P, A- Iru- Room I Length M," Width k-'® " Height 9'._o'� Windows and Doors—Crackage and Area --- Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width HeightNo. of Lineal ft. Area No. of pane of 'panelights of crack sq. ft. Coef. Btu Infiltration Coef. Glass Infiltration Exp. wall �® Net exp. wall Glass Int. wall Ceiling , Floor �•� . Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area n 1 41=. 62,--A D__— i r ,.__.1. i o 1 fi \4 A—L R 2^ i io;sl,► "_- Windows and Doors—Crackage and Area --- Width HeightNo. of Lineal ft. Area No. of pane of 'panelights of crack sq. ft. .53-4 Coef. Btu Infiltration 7& Glass Exp. wall �® Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I -?S6Pv r� and Area 4LS Pie -t*' eae�&,,je �D-S6 � 9 .:. afi 6 to � • n� l� '� m r2 t 9 B � HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS Coef. MINNEAPOLIS, MINN. Weatherstrips A.S.H.V.E. Guide Reference 19- Construction No. 3 S® Glass Insulation Windows I Doors Out. Wall Int. Wall Ceiling Roof Floor Kind How. Applied Yes—No Yes—No 9S ?0 - 1 Fl -I = ttk�rt1 Rnnm l Length R � A .," Width V,.#. 11 Fl.l Room I Length Width Height Windows and Doors—Crackage and Area JCoef.j Btu Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. ® 0 yvyo, Glass ,® Coef. Btu Infiltration Net exp. wall 3 S® Glass (-,S 5-0-._ Exp. wall® Net exp. wall Int. wall 9S ?0 - Ceiling f C _ L Floor i Total Btu. Sl a e Required sq. ft. E.D.R. or sq. ins. W.A. Leader area p Fl. � =�; o Room I Length I 1°0*' Width I"g" Height Windows and Doors--Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. ��l Z 2,1 7-4, 0 Windows and Doors—Crackage and Area JCoef.j Btu Infiltration ® 3,g,® yvyo, Glass ,® :56. Exp. wall Net exp. wall Net exp. wall Ceiling Int. wall Ceiling Floor f C _ L Total Btu. i Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl_l Renin 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. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area Width I Height No. of Lineal ft. Area No. of pane of pane lightsof crack sq. ft. Coef. Btu .Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.l 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. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I F1.1 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. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall , Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I City of Fridley Application for Plumbing and Comas Fitting Permit Dept. of Bldgs. Phone SU 4-1 DESCRIPTION OF WORK Number, Kind and Location of Fixtures I,ocaho PARTIAL RATE SCHEDULE 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 gre t�e and correct. Fridley, MinhI�1iM`M-M(-7 19� Owner f Kind of / Used as PLUMBING FIXTURE RATES: NO. RATE TOTAL /�� Number Fixtures x $1.50 $ Future Fixture Opening x 1.20 $ 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 TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ To be completed about Estimated Cost, Old—New. Build ROUGH & FINAL REPAIRS & ALTERATIONS—Refer to Code Description ............................................... $ TOTAL 0,42 2M 7-59 Business Phone Nom 15 '-2�L-w Z Z Z B WATER HTR. CQ� N Z S Z �0 R N GAS ELEC. Base { 1 1st 2nd _ 3rd _ 4th • Future Connection Openings I Connected with Sewer New .Fixture, Old Openings Cesspool El PARTIAL RATE SCHEDULE 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 gre t�e and correct. Fridley, MinhI�1iM`M-M(-7 19� Owner f Kind of / Used as PLUMBING FIXTURE RATES: NO. RATE TOTAL /�� Number Fixtures x $1.50 $ Future Fixture Opening x 1.20 $ 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 TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ To be completed about Estimated Cost, Old—New. Build ROUGH & FINAL REPAIRS & ALTERATIONS—Refer to Code Description ............................................... $ TOTAL 0,42 2M 7-59 Business Phone Nom 15 '-2�L-w ON sue�Et7 � PE City of Fridley 3 2 0 � 5 AT THE TOP OF THE TWINS BUILDING PERMIT q 6. —_____ COMMUNITY DEVELOPMENT DIV. moo: � PROTECTIVE INSPECTION SEC. r � I CITY HALL FRIDLEY 55432 NUMBER REV DATE =AGF APPROVEO BY 612-571-3450 910415 8/8/01 JOB ADDRESS 465 Rice Creek Terrace 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 1 1 Rice Creek Terrace, Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Fink, 465 Rice Creek Terrace, Fridley, MN 55432 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO B/B Remodeling, 6760 Madison St, Fridley, MN 55432 763-571-0248 9042 d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential CLASS of WORK ❑ NEW O ADDITION ❑ ALTERATION? REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Re -roof (tear -off) 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must meet State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING. TYPE OF CO ST. 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 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 $2,251.00 $1.13 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 PR ISI NS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $83.25 Fire SG $2.25 S RUCT ON OR THE PERFO ANCE OF N�STRUCTION PLAN CHECK FEE TOTAL FEE UM $86.63 s*NATUA)00VOtfTRACT&AORAUTmoRtzeOAGENT MATESW EN ROPERLY VALIDATED THIS IS YOUR PE IT ) ��/ _ S,GNATURE OF OWNERi60WNER BUILOE A, ABATE, L iZSP - DATE ON NEW I 1 Effective 1/1/2001 ADDN [) CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address t1v Legal Description: Owner Name Address: Tel. # _ Contractor:A/A MN LICENSE #�- Address: L --::� Tel. ia.�.5�� e c a 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• AZ7A::2� Estimated Cost: $ C;P� C22S Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DAT �D APPLICANT: ���� G Tel. #� ` -- e CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ ?S Fee Schedule on Reverse Side Fire Surcharge $ e?5�- .001 of Permit Valuation (1/10th%) State Surcharge $ 1,13 $.50/$1,000 Valuation SAC Charge $ $1150 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: n /I i SUBJECT PERMI City of Fridley 444 AT THE TOP OF THE TWINS BUILDING PERMI T RECEIPT NO. COMMUNITY DEVELOPMENT DIV. y — PROTECTIVE INSPECTION SEC. / � r /r I � 1 NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55032 763-571-3450 910-F15 4/16/03 JOB ADDRESS 465 Rice Creek Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DES CR. 12 1 Rice CReek Terrace Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Fink 465 Rice Creek Terrace NE 763-571-1184 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same a 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 O NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside House & Garage 9 CHANGE OF USE FROM TO STIPULATIONS Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive barrier be placed over exterior sheathing to protect the interior wall covering. Exceptions for this provision would be if sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in their application guidelines. Call for inspection of wrap before covering or take pictures. Caulk and flash all exterior openings. 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 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 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 $2,500 $1.25 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR L AL LAW REGULATING CON. PERMIT FEE SAC CHARGE STRUCTION R THE PERFORMANCE OF CO TRUCTION $83 ZS Fie SC$2.50 PLAN CHECK FEE TO FEE $87.00 . G kJUrEOFCONT ACTOR OR AUTHORIZED AGENT IDATEI Vy E PRO VALI D THIS IS YCOR PERMIT g INSo sa �+AtE S-GNATuaE OF OwNEaOc OWNER BWLOEAi IDATEI n /I i NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: o fay Legal Description: Owner Name & Address: �i? a. [.t) l Tel. # Contractor: D GcJ PL., z g MN LICENSE # Address: %/,!;— A) 4-0- C� �'��° w V fr Tel. # 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. �l h OTHER: Construction Type: /� ���' Estimated Cost: $ ®� Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: I&L,L .3 APPLICANT: � � � -, l c a I'� - Tel. # Si/ Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $ A53.zs- $ .2..5-0 $ A Z5* TOTAL $ A97, 00 Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 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 [ ]