PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
47 - 6 - j -
Date: .. ..... ...
Address ......................................
N? 3424
Builder .............
Address ...........................................
r� LOCATION OF BUILDING
No. Street ....'e .. . .. . art of Lot .. ;P 07
Lot ..... ..... Block ...... I .......... Addition or Sub -Division ... ... ......
Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ...........................
DESCRIPTION OF BUILDING
To be Used as: , .'
... .. ... Height ��: �?.. sq. Ft. fib... Cu. Ft
Front Depth ?7A:
.................... Front ........ Depth ........ Height ........ Sq. Ft......... Cu. Ft.........
Type of Construction ................... Nfft. Cost., .. .. To be Completed ...................
In consideration of the issuance to me of a permit to construct the Wding desribed above, I agree to do
the proposed work in accordance with the description above set fo in comp ce with all provisions of
ordinances of the city of Fridley. /
..........................
In consideration of the payment of a fee of $.�l......... permit is he eby 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.
+.
. ... .s... Building 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 items.
Date: July 27 ,9 1965
CLAYTON CION
Builder
G2 '47.5-
N? 8275
BLA M IS CONSTRUCTION
Address 63.3 Rice Creek Terrace Address 10152. Butternut St. N.W.
Fridley, Yjinn.esota. Coon Rapidsa Minnesota
No. 633 Street
LOCATION OF BUILDING
RI CEE CREEK TIIACE Part of Lot
Lot _ Block Addition or Sub -Division
Corner Lot _ Inside Lot setback Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Bldg onpres. basmt. Front Depth Height Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Fat Cost -0//.
0/ • 0 6 To be Completed
Repairs — Storm Damage
In moderation 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 a'll provisions of
ordinances of the city of Fridley.
9�zs-.=i�'�
In consideration of the payment of a fee of S_ 10.00 , permit is hereby granted to CLAYTON CARLSON
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 p 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 violation of any of the provisions ii said
ordinances.
!ALLEN G. JENSEN Building Inspector
NOTICE:
Ibb pgntsh don rot corer the construction, hahllation for wkb& ph mbieg, gas hoatb& sower or water. Be sure to we
dw Building b gmftr for apwaft permits for thea Dena.
APPLICATION FOR BUILDING PERMIT
CI* OF FRIDLEY, MINNESOTA
OWNER'S NAME A BUILDER
za :ate �.
ADDRESS OL /� 7;,-t-&aeADDRESS i A, h6a-
LOCATION OF BUILDING
NO, 3 3 STREET PART OF LOT
•y
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
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as: �� t 'da c ���' -k
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction
yP _ rR � Estimated Cost
,� _�
T,�,% ��0,9
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 SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
11� �Rly-7S—
City of Fridley, Minn. N° 8276
BURDING PERAUT
Date: July 27, 1965
Owner: CLACTON CLUSON Builder BL LINE' S CONSTRUCTION
Address 633 Rice Creek Terrace Address 10152 Butternut St. N.W.
Fridley, Minnesota Coon Rapids' Fdmesota
LOCATION OF BUILDING
No. 633 Street RICE CREEK TERRACE Part of Lot
Lot Block Addition or Sub -Division
Corner Lot Inside Lot Setback Sideyard 51
Sewer Elevation _ __ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
New Att._ Garage Front 16 Depth 24 Height 10 sq. Ft. 3:84 Cu. Ft. 3840
Front Depth freight Sq. Ft. Cu. Ft.
Type of Construction Frame Est Cost $1,9600,00 To be Completed Sept 31 1965
New Attached Garage
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 of l provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 4`00 --,permit is hereby granted to CLAYTON CARLSON
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, Mtnnesotaregardinlocation, construction, alteration, maintenance, repair and moving of buildings
within the city ]units s permit may be revoked at any time upon violation of any of the Provisions of said
ordinances.
ALT N G. JENSEN
Building Inspector
NOTICE:
'Me peradf don not cover the constroaldon, datail len for wiring, plumbing, gn baring, newer or water. Be ams to we
the Building Mgmter for apmft permits for thea hone.
0,
APPLICATION FOR BUILDING PERMIT 3g i
fs
CITY OF FRIDLEY, MINNESOTA
OWNER'S LYt]L'.tEBtJ.LLDER
ADDRESS `, ADDRESS ,%P/Jn A<
LOCATION OF BUILDING" AL
N0+ 43 3 STREET PART OF LOT
LUT BLOCK � ADDITION OR SUBDIVISION
CORNER LOT INSIDE LOT_A�_SETBACK SIDE -YARD
SEWER ELEVATION FOUNDATION ELEVATIOR
`'Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
J
DESCRIPTION OF BUILDING
To be used as;
FrontDepth 2L2�' Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction --t`���,, Estimated Cost 14 06
®_
To be completed 3
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 ��� 3� SIGNATURE s
(Schedule of Fee Costs can be found on the Reverse Side).
t
34
NORTHERN STATES POWER COMPANY
MINNEAPOLIS. MINNESOTA 85402
August 12, 1965
Fridley City Hall
City of Fridley
6+31 University Ave. N.E. `
Fridley, Minn. 55+21
Attn: Mr. Jensen, Building Inspector
Dear Mr. Jensen:
Please'be advised that we have no objection to the
encroachment of a garage to be built on.the utility ease-
ment on the property of Mr..Clayton Carlson at 633 -Rice
Creek Terract-, City of Fridley.
It is our understanding that the garage will encumber
the easement approximately 22 feet. This will not affect
the operation and maintenance of lour facilities.
Yours truly,"
T.S. Jepson
Electric Distribution Superintendent
Minneapolis Division
By
oy . erson
Se or Right of. Way Agent
TS J
JCP
RHA/kep
cc: Mr. Clayton Carlson
5851 2nd St. N.E'. Apt.,•.#�
Fridley, Minn. 55421
1NSp
NORTHERN STATES POWER COMPANY
MINNEAPOLIS. MINNESOTA 55402
August 12, 1965
Fridley City Hall
City of Fridley
6+31 University Ave. N.E.
Fridley, Minn. 55421
Attn: Mr. Jensen, Building Inspector
Dear Mr. Jensen:
Please be advised that we have no objection to the
encroachment of a garage to be built on the utility ease-
ment on the property of Mr. Clayton Carlson at 633 -Rice
Creek Terrace, City of Fridley.
It is our understanding that the garage will encumber
the easement approximately 22 feet. This will not affect
the operation and maintenance of our facilities.
Yours truly,
T.S. Jepson
Electric Distribution Superintendent
Minneapolis Division
By
V '•y rn-derson
Se ior Right of Way Agent
TS J
JCP
RHA./kep
cc: Mr. Clayton Carlson
5851 2nd St. N.E., Apt. #3
Fridley, Minn. 55.21
MINDERENGINEERUNG CO.,911-
ENGINEERS AND SURVEYORS
LAND SURVEYINO 801 LS
CIVIL & MUNICIPAL ENGINEERING LANA PL
G418-5GT" AVENUE N.
MINNEAPOLIS 2T. MINN.
d KE 7- SG37
10_
M
15 a
S 3 I -e
WE HEREBY CERTIFY THRT THIS ISR TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE Boull
'LAND ABOVE DESCRIBED AND OFTKE LOCATION OF ALL BUILDINGS, IF ANY, THEREON, ANO ALL VISIBLE
IF ANY, FROM OR ON SAID LAND. MINDER ENGINEERING CO., It,,
GATED TNIS EAY OFn71e err �' �'r' AO.I-)Sg
EN61fJ�ER$ AIID SURY£YORS
cation for Power Plans and Hea tg. CocangE Veno a ba. Refr4amtjon and
Air CORMOning Sys and Devices
-PART
IAL RATE SCHEDULE , Emm• wi nwge. Phone 56"M
GRA4IrY WHAM AIR= iu►rlG rorAL * ---•--
Furnace Shell & Duct Work ................
.. $10.00
$
Replaceriient of Furnace ..... ........
8.00
$
Repair% Alterations—up to $500.00
6.00
_
$
Repairs & Alterations each add. $500.00
3.00
MECH. WARM Ant
Furnace Shell & Duct.*Ork to 120,000 BTU ........
..$10.00
$
each .add. 80,000 BTU ....................
.. 3.00
;
Replacement of Furnace
.... 8.00
Repairs & Alterations—up to $500.00
8.00
$
Repairs & Alterations each add. $500.00 ......
&W
$
STEAM at HOT WATER SYSTEM
Furnace Shell & Lines—to 4004q. ft. EDR Steam
$10.00
$.
Furnace Shell & Line,—to 640 sq. ft. EDR Hot Water
10.00
$_
Each add. 200 sq. ft. EDR Steam
9.00
Each add. 320 sq. ft. EDR Hot Water
3.00
$
OIL BURNER—to 3 gal. per hour
8,00
$
over 3 gal. per hour—See Fee Schedule
€..
GAS B (up to 199,000 BTU)
8.00
$
over 199,000 BTU See Fee schedule
GAS PITTING
NO RATE TOTAL
1st 3 Fixtures
x$ goo
$
Additional Fixtures
x .75
$
Gas Range to 199,
X$ 5.00
$
AIDC CONDITIO G,
_3 .
FAR HEATING SY8TZM Sew Few schadiub
VENTILATING BYSTEN$
ALTERATIONS & REPAIRS TOTAL FEE
$
ROUC;H
i -
City of Fridley: ' . f -
The undersigned hereby makes application for a permit for the work :hereir.
specified,. agreeing to do all work in strict a&ordance with the City Ordinance:
and ruling of the Department of Buildings; and hereby declares that an the facts
and representations stateoln'this application are true and correct.
9
Fridley.
Minn_
Owner
Kind of Building .TA
ti.
Used as _ —
To be completed about __. l� 9 2,
Estimated Cost, $__ _r ��_
Building Permit No.4A
Permit No.
HEATING or PO team, Hot Water, Warm Air—No
Trade Name Sine N m
CapacitY' Sq. Ft. F.D.R BTU Hy -
Total Connected Loan Kind of Fuer
BURNER — Trade RTam@ Size No
Capacity Sq. Ft. E.D.R BTU
(REMARKS -OVER)
Budness Pherne No- '7
E
SUBJECT
P
City ®f Fridley
21399
AT THE TOP OF THE TWINS
BUILDING PERM
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
_
v PROTECTIVE INSPECTION SEC.
d ;
4
,
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
9t0 -F15
6/12/912
JOB ADDRESS 633 Rice. Creek Terrace NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
1
1
Rice Creek. Terrace Plat 7 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Dorothy. Carlson 633 Rice Creek Terrace NE 571-6532
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Twin City Storm Sash Co Inc, 10825 Greenbrier Rd, Mtka 55343 546-8160 3090
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 ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace soft t & Fascia
9 CHANGE OF USE FROM TO
STIPULATIONS
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
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
$1,650 $. 83
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.
$39,00 Eire SC $1.65,
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTALFEE
License SC $5.00 $46.48
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
^,�y EN PROPE Y VAL THIS IS YOUR PERMIT
ATP
-1�-/2--
8 G )NSP GATE
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
E
NEW [ ] (� Effective 3/1/92
ADDN [ ] CITY OF FRIDLEY
ALTER [ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address:
Legal Description:
Owner Name & Address:
Contractor: --nAnN r
DMI 1 a,
Address: ®x,.10825 GREENBRIER ROA®
Tel. # 54L�U�-)n
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF ff"ROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] inside Lot Ft. Yd Setback Side Yard Setbacks
Type of Construction:0 C1 , L � - �) Estimated Cost: $i(o c
Approx. Completion Dater
(Cost on Back)
p
Driveway. Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE:
9 ';z APPLICANT: Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
$ 06
$ 4.S;
$
Driveway Escrow $
Park Fee $
Sewer Main Charge $
TOTAL
STIPULATIONS:
CITY USE ONLY
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 [ j Not Necessary
`L��T ��/
CITY OF FW DLEY iNSPECTION DIV.
5431 University Ave NE Effective An January !.1997
Fridley. MN 55432 APPLICATION FOR PLUM BI D OAS FITTING PERMIT
572-3604
MARK NUMBER OF FIXTURES TO BE INS. N EACH FLOOR
Stories man
. .. �: Wash Grii Auto.
^q: "`�• Gas :!K`'. : Water Heater
CfipseiM Unna[ Shower Tra z6 Washer'Gas Qec
::�.' 'z: Range
Basement
:1. IN ?,.rr�: :.
., :', :+a
r .ti^r,'.9C�:�tii9.\: .�NC:':i'4.v:: .:ddN �.. n. :�4.:'.
Floor 2 ss E«:.
Floor 3 <<:� :;::< :....
Floor 4 " `_": • •. < _->.: =• g:
::
:,�:� ''::1r ;;wN,yi:•.t�` ..!rttyS•. ' . 44 i. M:%�;•
A
PLUMBING FU(TURE RATES: NO. RATE TOTAL JOB
New Fbctures
$7.00
® The un by makes application for a permit for the work herein
Old Opening. New Fixture $4.00 specifi do all work in strict accordance with the city codes
Beer Dispenser $5.00
Blow Ott Basin and ruQn BuDdtn9 Division, and hereby declares that all the fads
S 7.00 and• re' >9 stated in this application we true and correct
Catch Basin $7.00
Rain Water Leader s 7.00 ` 1a eel
Sump/Recetving Tank 37.00
Water Treating Appliance $10.00 Owns
Water Heater —Electric $7.00
Water Heater —Gas"•
$1 0.00
Building
Gas Ranga** $10.00 ter-
Gas D 0—
rYer'• 3!0.00 tstim PERMIT NO.
Back Flow Preventer Required ( )Yes O No
Type 315.00 PLUMIN MR. ROOTER OF ANOKA COUNTY
n Us ry AVe.
Reinspection Fee $42.00Ii-tr SIGN ' Ramsey, MN
ALL OTHERS ANO/OR REPAIRS AND ALTERATIONS 421-6140--
1.5%
21-fi 4Q!.5% of Value of Fixture or Appliance �, 0® � 421-61 -F
APprQ uglotn Date Final Date
State Surcharge 3 ,�
MIM F RPLUMIXINIGIGAS PERMIT IS$0.00
TOTAL FEE &0 30 S!PCEARG it tj ��G��
*"COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION SO4(A)A. MINIMUM SIZE 9 80 INCHES.
NEW [ ] CITY OF FRIDLEY Effective 4/1/2004
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- l' ' _ (4 Il '
Legal Description -
Owner
Contractor -Nim l (I 1. ► i hLl :r '
Address'�''J 'C !�� i �.%i. SIL til - i
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:
r -'E
Construction Type: '2 Estimated Cost:
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $
DATE: ® APPLICANT:.a 4224 Tel. #
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.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
h
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
9>
$.50/$1,000 Valuation
$1350 per SAC Unit C9
$5.00 (State Licensed Residential Contractors) '-�
Alt. "A" or Alt. "B" Above
/W9
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS:
!I��ev �Ay a� �eJ LccEnll£
Building
Inspections
763-572-3604
DATE
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
0-7 _ - YOUR
❑ OWNER
NAME:
ADDRESS:
PHONE:
COMPANY NAME__
CONTACT PERS(
STATE LICENSE #_
ADDRESS:
PHONE
`SINGLE FAMILY ❑ TWO FAMILY
NEW KUTLACEMENT
DETAILED DESCRIPTION OF WORK
410 WEST LA -
�J,, MN 55408
2- 24 -
FAX
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
M
Permit
Received
STA
STATE ZIP
PER MS 16B.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
only the cost of labor )
improvement, installation or replacement of a residential fixture, excluding the fixtures. _(This
should reflect
Labor cost under $300 = $15.00.
Labor cost between $300 to $500 -cost of labor
X .OS
FOR PROJECTS WHERE LABOR EXCEEDS $5 , FEES ARE $ ED ON $10.00 PER FD[I'URE, EXCEPT WHERE NOTED. FIXTURES,: (INDICATE TOTAL
NUMBER OF EACH BELOW) 4 6
Equipment Installed
MF MODEL:
MODEL:MFGMODEL:
SIZEiBTU
SIZEBTU
Z= $25.00
6&FKMMRE3PnfLAACE (GAS) $15.00
GAS RANGEIOVEN $10. 0
NEW GAS GRILL. $10.00
AIR TO AIR EXCHANGEER $15
—BOUER
FIREPLACE (WOOD) $35.00
CE $35.00
GAS UNIT HTR $10.00
$35.00
CHIMNEY I INER $10.00
GAS DRYER $10.00
$10.00
POOL HEATER $35.00
VENTII�ATOR $15.00
DUCT WORK $10.00
GAS PIPING
Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ _ .50 Number of fixtures @ $15.00 x $15.00= $
TOTAL DUE $ Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $ e
State Surcharge = $ .50
Total = $
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 a City of Fridley and with the Nrumesota Construction Codes; that I understand this is
not a permit but o ap 'cAtion f r and work is not to start without a permit; that the work will be in accordance with the
approved plan ' the f work w ch s review and approval of plans.A-vi 1p,^ ( �
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-5024977
Building -
Inspections
763-572-3604
763-502-4977 FAX
SITE ADDRESS_ i P
THIS APPLICANT IS:
PROPERTY OWN]
TENANT
CONTRACTOR
SUBMIT' A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK;
DESCRIBE WORK BEING D
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUA*
�v
BUILDING Permit No.;
RESIDENTIAL APPLICATION. Received B
CITY OF FRIDLEY Date ',
YOUR EMAIL ADDRESS
PHONE LkS 11 ` K I -P-!!- .9 4, �66P
STATE LICENSE # _ / 7 �Z
SINGLE FAMILY N
❑ TWO FAMILY/NEW CONSTRUCTION
❑ BASEMENT FINISHpOg.
❑ DECK ❑ SIDING
HOME CONSTRUCTION ❑ ADDITION
ITENANCE!REPAIR [3 REMODELING
OiiOUSE ONLY
❑ HOUSE & GARAGE
GARAGES
PROPOSED SIZE:
❑ ATTACHED GARAGE
PROPOSED HEIGHT:6 1
❑ DETACHED GARAGE
SIDING.
! i
. OCCUPANCY TYPE
Permit Fee
❑ Vmyl
❑Soii'it
❑ Aluminum V
❑ Trim
❑ Other
® Fascia
WINDOW
Surcharge
INEXISTING OPENINOS ❑Yes ONO LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
License Surcharge
OPENING CHANGES &
•$5.00 (State Licensed Residential Contractors)
TYPE OF. WINDOW TO BE INSTALLED
NUMBER OF WINDOWS
PAMENTREMODELING SUBMIT
L Existing Floor Plan
. 2. Proposed floor pian
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS & ?(RQ n IRM] j
L Site Pkn/Swvey showing the existing st ucum
and proposed project.
2. Two sets of conshuction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND 1V1A'I`�'ulsl c;
(�
3
THE 1997 JMC FEE SCHEDULE)
COTAL JOS VALUATION $
! i
. OCCUPANCY TYPE
Permit Fee
$
, 2. Back Page for. Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$ _ .001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Mmimum $.50
License Surcharge
A---2(L-5--1V
•$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft+ 6 ft=R x $21= $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
- -, Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary
Total Due
$—
Make checks payableto• City of Fridley Attach
THIS IS
APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a braiding permit and I acknowledge that the brfonnation above is complete and acwnate• that the work win 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 on site; that the work wiD mi ce whir th in the case of an work which review and a f plana. �2
SIGNATURE OF APPLI PRINT NAME DATl .
APPROVED BY _ DAT5-bTkk