PRE 2010 DOCSCity of Fridley, Minn. N° 8970
BUILDING PERMIT
Date: AUGUST 17, 1966
Owner: WILLIAM F. FINK Builder
Address 6101 STARLITE BOULEVARD Address
FR.IDLEY, MINNESOTA 55421
No. 6101 Street
Lot 12 Block
LOCATION OF BUILDING
STARLITE BOULEVARD Part of Lot
2
Addition or Sub -Division SYLVAN ELLS, PLAT 2
Corner Lot — X Inside Lot _ _ Setback __ Sideyard 25'
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
ATT. GARAGE Front 22 Depth 25.4 height 10 Sq. Ft 55 0 Cu. Ft 5,500
Front Depth Height Sq. Ft — Cu. Ft.
Type of Construction FRAME Est Cost r 2�0 _ 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 aak provisions of
ordinances of the city of Fridley. -
In consideration of the payment of a fee of $6.00 -,permit is hereby granted to WHIM F. PINK
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 nay pmt thereof, shall oanform in all respects to the ordinances of
Fridley, Minnesota reg location, conatructioa, alteration, maintenance, repa9r sad moving of buildings
within the city limits aa� permit may be revoked at any time upon violation of any of the provisions of said
ordtnanca3s.
CLARENCE BELISLE Building Inspector
NOTICE:
Ub permit don not cover the coestroction, hufaMen for v Mhe, phnnbbna, Bas hoafin& sewer or water. Be sore to no
the Bo Mh* Inspector for sepotle pen dts for these Nems.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAM�/I %II 1lL
BUILDER
x,
ADDRESS 1/ / _Aa ADDRESS.
LOCATION OF BUILDING
N0STREET _2 1-z-(�17 PART OF LOT
LOT 2s BLOCK ADDITION OR SUBDIVISION
CORNER LOTINSIDE 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:
-� 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.
N
e
DATESIGNATURE�Z'; c �_
(Schedule of Fee Costs can be found on the Reverse Side),.
SUBJECT
PERMI
City of Fridley
19 968
AT THE TOP OF THE TWINS
BUILDING
PERMIT
R
�
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
��� c;7r
1 � �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L J\ 612-571-3450
910-F15
6/27/89
JOB ADDRESS 154 Longfellow Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
37,38
4
Spring Brook Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Leonard Benser 154 Longfellow Street N.E.
784-6251
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Same
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
Reroof.Dwelling (.15 Squares)
9 CHANGE OF USE FROM TO
STIPULATIONS
Roof can be 2nd layer but not 3rd. Install ridged galvanized valleys.
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$750
$.50
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-
$21.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$21.50
SIGNATURE OF CONTRACTOR OR. AUTHORIZED AGENT (DATE)
1 - WHEN PROPERLY V ED THIS IS YOUR PERMIT
SiGNATURE OF OWNER 0F OWNER BUILDER) IDATEI
BLDG )NSP
DATE
Mm I
ADM [ ]
ALTER [ ]
Construction Address: /.7
R-1 AND R-2
Building Permit Application
Effective 5/1,/88
Legal Description: .:--i✓
Owner Name & Address: Tel #
Contractor: L
Address:
Attach to this application, a Certificate of Survey of the
lot, with the Proposed const ictim drawn on it to scale.
DESCRIPTIarT OF IIVF1►�n'
LIVIM AM: Length gVe� Width 94, Height Sq. Ft.
C:RMM AEE,: lexqtA Width Height Sq. Ft.
U= Aim: length Width Hgt/Gmauxd Sq. Ft.
o►�t: 7S- (."a -"t az
Corr Lot [ ] Inside Lot ] Ft. Yd Setback Side Yard Setbacks
7YPe of Cmwtructian: Estimated Cost: $
Apprmc. Campletion Date:
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
Width + 6' See Back Page
DATE: APPLIaW: Tel. #
Permit Fee $ /. () U
State Surcharge $
SAC $
Driveway Escrow $
Park Fee $
Sewer Main Charge $
STIPUUMMS:
CITY USE ONLY
Fee Sd2e2ule an Reverse Side
$.50/$1,000 Valuation
$575 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined byi rri
Aunt Necessary j ] Not Necessary [ ]
01
SUBJECT
ITERMIT
City of Fridley140
19967
AT THE TOP OF THE TWINS
BUILDING PERMIT
-
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
/�--t CITY HALL FRIDLEY 55432
1•j
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
6/27/89
JOB ADDRESS 6101 Starlite Bou.lev wd N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
12
2
Sylvan Hills Plat 2 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Lorayne Fink 6101 Starlite Boulevard N.E. 757-2582
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
DuAll Services 636 -39th. Avenue N.E., Columbia Heights, 55421 788-9411
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
Fire Repair
9 CHANGEOFUSEFROM TO
STIPULATIONS
Provide fire alarms on both levels of dwelling
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. 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
I 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
$ 30 QO.Q
$15.QQ.
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-
$284.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$299.5Q
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLYLIDATED THIS IS YOUR PERMIT
i
BLDG WSP DA
SIGNATURE OF OWNER OF OWNER BUILDER( (DATEI
01
NEW [ ]e djoe-Q
ADEN [ ]
ALTER [ ]
R-1 AND R-2
Building Permit Application
ClonstnUction Address: CQ I b ! G1'" 1 t -Y 61%j 421
Effective 5/2,/88
legal Description:
Owner Name & Address: _ Lo e Ay tjl�q G i;� Tel.
AU
�� V �� Tel.
• # 7 $ `til 1
Address: �� '�' L, C0(, 4 l
Attach to this , a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
D tIMCM OF I' I Ovim=
LXVIM AREA: lengt • Width height Sq. Ft.
GRRAM ARS: nth Width Height Sq. Ft.
E= ARS: Length Width HWaraund Sq. Ft.
OTR•
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Orion: Estimated Cost: $OZ5,-o
Apprmc. Completion Date: I't
Proposed Driveway Width If New opening Is Desired: Ft. $ $
��,,• Width + 6' See Back Page
DATE: 7 APPLICANT: p(6 Tel. # 1 fS% --q q 11
State Surge $ f r p (I
SAC Charge $
Driveway Escrow $
Park Fee $
Sewer Main Qkarge $
SZTPULATIONS:
CITY DBE Oi�II,Y
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$575 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by
Necessary t ] Not Necessary [ ]
O� LOWE s
�, oo •
251. o0
SY`.S� 3t,3�
a
sue�ECi
PERMIT NO.
City of Fridley
2 815 0
AT THE TOP OF THE TWINS
BUILDING
PERMIT
COMMUNITY DEVELOPMENT DIV.
f
`- _ ___
r PROTECTIVE INSPECTION SEC.
1 . �
NUMBER
REv
OAT
110/8/98
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
JOB ADDRESS 6101 Starlite Blvd
I LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
12
2
$ lvan Hills Plat 2
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Lorain Fink
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Advance Aluminum Supply Inc. 7701 Main St NE Fridley 55432
571-3440
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW 0 ADDITION ❑ ALTERATION Rk REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof house and garage (23 Sq) Tear-off-hail ama e • Reside -partial
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
Call for building wrap inspection before covering.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING. HEATING.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. 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
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
2471
$1.23
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$74,75
Fire SC $2.47
PLAN CHECK FEE
TOTAL FEE
IT-4panca
SC 5.00
83.45
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERL !LIIDDAAATED THIS IS YOUR PERMIT
S-GNATURE OF OVVNER IIF OWNER BUILOERI IDATEI
BLzn INSR
6ATE
a
r y
NW []
~ADDN [ ]
ALTER [ ]
2 612 571 2260
ADUANCE ALUMINUM
Effective 1/1/98
CITY OF FRIDLEY 'A�
p " ,/'50
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 S-�®-j 7
BUILDING PERMIT APPLICATI®N
S7:2 -366Y
ConstructionAddress: 4) 0 1 5 �d9a� t- 17x 1'C_1147
01
Legal Description: ....
Owner Name & Address: b /Z l &K Tel. #
Contractor: A O ✓";" e'MN LICENSE #
Address: '17 -'JG Ag 4r.i.- S: ^-'qc 6-*' 9,p(V..x 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 Ileight __._ Sq. Ft.
DECK AREA: Length _ Width _ Hgt/Ground Sq. Ft.
Iq
Construction Type: o v /✓. e niv,�- s & Estimated Cost:
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ -- $,_,__
DATE:/ — APPLICANT: -. v Tel. # st z / — 3`yQ
Permit Fee $
Fire Surcharge
$
• '41%
State Surcharge
$_�
1. -�3
SAC Charge
License Surcharge
$
S-. oc)
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
CITY USE ONLY
Fee Schedule on reverse Side
.001 of Permit Valuation (1110th%)
$.50/$1,000 Valuation
$1000 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 [ ]
TOTAL $
4/S®
STIPULATIONS:
,tw
:.ITY OF FRIDLEY INSPECTION DIV.
3431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO RF INSTAI I Fn ON FArW FI nnR
Effective On Jan 1, 2000
R r..
tR
•
R'
�
oo ,. ' R�'R
•
��
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
NO. RATE TOTAL
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas**
Gas Range`*
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
Type $15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge $ .50
TOTAL FEE $M._550
JOB ADDRESS_ 3$NIE- ts dWO l -
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Puilding Division, and hereby declares that all the facts
.and representations stated in this aDDlication are true and correct.
FINK, LORAYN
6101 STARLITE BOULEVARD N.E. j
FRIDLEY, MN 55432 ' 20��
(763)571-4428
Owner _
Building Used As S-aiCz i r:.)J&' n e 4er- 4 ,
Estimated Cost PERMIT NO.
PLUMBING COMPANY C?i^��'11•��ZUI✓d�i�Cr ��
SIGNED BY _ L NO.410-8Z7-yo �
Approved By Rough -In Date Final Date
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, 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( ) No( )
The venting: system is, plastic/PVC and meets all current codes and manufacturer
specifications .including sizing, length, number of elbows and termination.
Yes O 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 ( ) No
When instailina 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( ) 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
3uilding011- BUILDING Permit No.:
Inspections RESIDENTIAL RESIDENTIAL APPLICA'TI®N Received By:
763-572-3604 CI7['�r �]� ��� '�O&
SATE �®� / D YOUR E-MAIL ADDRESS
-010. r�1LJi%F11YG/
i ■•
PROPERTY OWNER/
NAME:
See Back Page for Fee Schedule
Plan Review
TENANT
ADDRESS:4 //1 / SJ—P
Y Ll 8T
CITY STA _ Z
.001 times the total job valuation
PHONE: ":.'4a
$ 1-6(a
CONTRACTOR
NAME: U ®r ei-
! oxs °
SAC Charge
$
STATE LICENSE # /mss 6
4- EXP DATE '�3 JD
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: D
- S` >
�� Aly l �rr�
CITY f STATEt'�` QIP °��20
WITH APPLICATION
PH6NE
FAX
J, -1
PROPERTY TYPE
SINGLE F Y
Agreement necessary ( ) Non Necessary ( )
IZE
$ 011, 455
D TWO FAMILY/NEW CONSTRUCTION
STORIES
PERMIT TYPE
0 ADDITION
0 GARAGE/SHED
INDOWS
0 BASEMENT FINISH
0 ROOF
0 DRAIN TILE
O DECK
0 SIDING
0 OTHER
0 SWARMING POOL
TYPE OF WORK:
0 NEW
0 ADDITION
❑ MAINT SIANCE/REPAIR
0 REMODELING
DESCRIBE WORK BEING DONE: 1e10i r — SA7L't-e. Qom+ o�,� .
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft.
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
0 Vinyl
0 Aluminum
0 Other
0 HOUSE & GARAGE
0 ATTACHED GARAGE
0 DETACHED GARAGE
OSoffit
0 Trim
0 Fascia
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project_
WINDOWS 2. Two sets of construction plans
IN EXISTING OPENINGS DYes ONo LOCATION OF WINDOWS 3. Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS r
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ o? I Q4." OCCUPANCY TYPE
Permit Fee
$ a 2, �y 5
See Back Page for Fee Schedule
Plan Review
$ m
65% of Building Permit Fee
Fire Surcharge
$ _ 1 Z
.001 times the total job valuation
Surcharge
$ 1-6(a
.0005 x Permit Valuation Minimum $.50
License Surcharge
$ ,��—
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1550 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21= $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$ 011, 455
Make checks payable to: City of Fridley Attach Stimulations
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 it
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not
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 wok hich esu' s review and approval of plans. �/
SIGNATURE OF APPLIC PRINT NAME (TAWJ9.9- U 1ZV�1�DATE / —Z_ '6 7