PRE 2010 DOCSS�
City of Fridley, Minn. ;
6431 University Ave. N.E., Minneapolis, Minn. 55432 PERMIT BUHDING 1 E . T
Date: May 13, 1971
Owner: William Dieck Builder Same
Address .-.-.2-UD Ards -n Avenue. Mpj,s___•___•� Address Game
No. l b1..__._.._.... Street --._Ta lma g e Way N _ F _ Part of Lot
Lot ..-.._.....5..-_.r..._._. Block .__...__._lAddition or Sub -Division , _E> we l l' s R iy ers i e Reights
Corner Lot .._._X_.._..... Inside Lot Setback 35' Sideyard
Sewer Elevation —_ — Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Dwelling —___ Front _ 26' Depth 40' Height 20' Sq. Ft. 1040' , cu, Ft. 20.800'
240TyGarage --- Front 26' Depth 24' Height 10' Sq. Ft. 624' Cu. Ft. _ 6240-
Type
pe of Construction Frames Est. Cost __420.,.1a.0.0.....-.._____ To be Completed 1 gear
Provide verifying survey and hard surface drive. Maintain Elevation of Minimum 18"
above centerline of street.
WATER LOCATION: 16' East of Manhole, SEWER LOCATION: 23' Lead, 26' East of Manhole
Sewer elevation: 850.92 Top of Footing if 35' NX Away 853.92
In consideration of the issuance to me of a permit to construct the buildingdescribed 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.
a q,
In consideration of the payment of a fee of $ 52 00 , permit is hereby 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
pyithin the city limits and this permit may be revoked at any time upon violation of any of the provisions of Said
ordinances.
AL 'a&l Building Inspector
t
NOTICE:. i
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we
the Building inspector for separate permits for these neons.
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME:
O/,�ff 7C &
BUILDER:
ADDRESS: ,_? /a
a:jCg�,
.ADDRESS:
_
,�) NO:. 11Y STREET:- c' -
LOT : 5 BLOCK: / ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: -7-5- SIDEYARD:
/ Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
Ci
To Be Used As:
,N Front: (o
�l Depth'
Height:
Square Feet: ® Cubic Feet:
Front: cZK Depth:__ ® Height: /
Square Feet Cubic Feet 6 0
Type of Construction: Estimated Cost:_$ 00 0,
- To Be Completed:
f
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict accordance with the City of
�Fridley Ordinances and rulings of the Department of Buildings, and hereby
g,declares that all the facts and representations stated in this application
Q,- are true and correct.
DATE : ' _ /���° SIGNATURE :�
(See Reverse Side For Additional Information.)
-� f V
BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any existing
building or structure, or for any alteration or repairs to any existing
building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in
the manner herein provided to -wit:
UNIFORM BUILDING CODE: Type 1, 2 & 4 - $2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3 & 5 - $1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average.*
height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours from the
time of application, to allow for proper review of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued. I
Applicatim for Power Plants and Hsi, COORD9. Ventilation. Refigeration and
Air Conditioning Sptems and Devices
PARTIAL RATE SCHEDULE
GRAVr_" WARM AIR: RATIC TOTAL
Furnace Shell & Duct Work ................ .. $10.00 $
Replacement of Furnace . .. . ..... 6.00 $
Repairs & Alterations—up to $500.00 ... 6.00 $+
Repairs & Alterations each add. $500.00
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ... ....
each add. 60,000 BTV ....................
Replacement of Furnace
Repairs & Alterations --up to $500.00
Repairs & Alterations each add. $500.00
Dept. of Bldgs. Phone 1f80
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 an the facts
and representations stated in this application are true and correct.
..$10.00
$
3.W
; Ori
6.00
$ Kind of
6.00
$
1st 3 Fixtures .. . .....
Used as
3.00
$
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $.
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $_
Each add. 200 sq. ft. EDR Steam 3.00 $___
Each add. 320 sq. ft. EDR Hot Water 3.00 $_.!
OIL BURNER—to 3 gal. per hour 6,00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 189,000 BTI) ...
6.00
$
over 199,000 BTU See Fee Schedule
GAS FITTING FEES:
NO RAPE TOTAL
1st 3 Fixtures .. . .....
x$ 100
$
Additional Fixtures
x .75
$
Gas Range to 199,
z$ 5.00
$
AIR G
FAN HEATING SYSTEM
Be* Fee
SchedWo
YEPiT>a.ATIAG SYSTEM
ALTERATIONS & REPAIRS
TOTAL FEE
ROUGH
FINAL_J- / - % '
(SURCHARGE $_.,50)
To be completed about
Estimated Cost, $___.
Permit No,
Permit No. ��dy
HEATING or PO team, Hot Water, Warta Air No
Trade Nam Size N e
4
Capacity Sq. Ft. E.D.R B Hy
Total Connected Load s� Kind of Fuel
BURNER — Trade Names Size No
Capaci Sq. rL E.D.R BTU
iE!!
(REMARKS—OVER)
�l G;!,, PMPJ AIR CONDITIONING CO.
Sign
84;9 CENTER CRIVC
rAF(1 -- MINNESOTA 55432
Bar
City of Fridley
Applic®thm for Plondibg and Gen 1111hoing Pan*
DESCRIPTION OF WORK
Number. Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMMBING FIXTURE RATES: NO. RATE TOTAL
Number Number Fixtures ................ _/� x $2.00 $�
Future Fixture Opening ............ x $1.50 $
New Fixture Old Opening .......... x $1.50 $
Catch Basin .................... x $3.25 $
Water Heater :Up to 98,000 BTU) .... x $3.00 $
New Ground Run Old Bldg. ........ x $3.25 $
Eleatric Water Beater .............. : $2.00 $
GAS FITTING FEES: /NO. RATE TOTAL
1st 3 Fixtures . �L x $2.00 ; "? . 0-1
Additional Fixtures .................. x $ .75 $
Gas Range to 199,000 BTU.. . x $5.00 $
REPAIRS & ALTERATIONS—Refer to Cade
Description ...............................................$
TOTAL FEE
(SURCHARGE $_.5U)
Dept. of Bldge. Phone 9®0--34450
Leentie�. s�o .��"-�i '��:�l�•z; � �' Lam"'/ "
City of Fridley:
The .undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work In strict accordance with the City Ordinance
and railing of the Department of Buildings, and hereby declares that aR the fact
and representations stated in this application are true and correct
Fridley, Blinn-
Owner
inn Owner /L L e: 2/.E C'_ f 7
Kind of Building
Used as
To be completed about
ate`"
Estimated Cost, $
Old—New. Building Permit No.
Permit No.
i
Signed.
By -
Business Phune No 7�Z
ROUOB
FINAL �� 1- 7 �^
WATER WM.
GAS ELEC.
(A
Base
L
1st
2nd
3rd
44th_
• Futuro connectim Openings
Coaaeetad with
* New Fixture. Old Openings
y
Sewer
Cesspool El
PARTIAL RATE SCHEDULE
PLUMMBING FIXTURE RATES: NO. RATE TOTAL
Number Number Fixtures ................ _/� x $2.00 $�
Future Fixture Opening ............ x $1.50 $
New Fixture Old Opening .......... x $1.50 $
Catch Basin .................... x $3.25 $
Water Heater :Up to 98,000 BTU) .... x $3.00 $
New Ground Run Old Bldg. ........ x $3.25 $
Eleatric Water Beater .............. : $2.00 $
GAS FITTING FEES: /NO. RATE TOTAL
1st 3 Fixtures . �L x $2.00 ; "? . 0-1
Additional Fixtures .................. x $ .75 $
Gas Range to 199,000 BTU.. . x $5.00 $
REPAIRS & ALTERATIONS—Refer to Cade
Description ...............................................$
TOTAL FEE
(SURCHARGE $_.5U)
Dept. of Bldge. Phone 9®0--34450
Leentie�. s�o .��"-�i '��:�l�•z; � �' Lam"'/ "
City of Fridley:
The .undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work In strict accordance with the City Ordinance
and railing of the Department of Buildings, and hereby declares that aR the fact
and representations stated in this application are true and correct
Fridley, Blinn-
Owner
inn Owner /L L e: 2/.E C'_ f 7
Kind of Building
Used as
To be completed about
ate`"
Estimated Cost, $
Old—New. Building Permit No.
Permit No.
i
Signed.
By -
Business Phune No 7�Z
ROUOB
FINAL �� 1- 7 �^
City ®f Fridley
SUBJECT
Po 17557
AT THE TOP OF THE TWINS
BUILDING
PERMIT
Ir
�
R EIPT NO.
COMMUNITY DEVELOPMENT DIV.
y
r PROTECTIVE INSPECTION SEC.
/ a / y
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
`j
612-571-3450
910-F15
6/18/84
10B ADDRESS 161 Talmadge Way N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
Sl� of 5
1
Elwell's Riverside Heights SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Ray Schmidt 161 Tamadge Way N.E.
571-7199
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Gary Jansick Const. 6480 Squire Drive N.E., Fridley 574-9679
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 C. ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
Construct an 184-x 20" Addition to Dwelling
9 CHANGE QF USE FROM
TO
STIPULATIONS
Q
13 sys n�ad
3a1 - 0,810373
41nn -
��"a0I Ilea oHd�73�
.8u1.8.81
SE'PERgTE pERMTS
REQUIRED. -Of
HEATING. PLUMR14(4 FOR. WIRING.
ANP-'IGNS.
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
STALLS I 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
$18,950
$9.48
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-
None
STRUCTION OR THE PERFORM E OF CONSTRUCTION.
$134.50
PLAN CHECK FEE
TOTAL FEE
$ 33.63
$177.61
SIGNATURE OF CONTRACT O R AUTHORIZED AGENT (DATE) �'�
WHEN PROPERLY VALIDATED THIS iS YOUR PERMIT
�A
SIGNATURE OF OWNER of OWNER BUILDER) (DATE)
BLDG WSP DATE
01
NEW [ ] City of Fridley
ADDN. [ �R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address: ZA w���
Legal Description
Owner Name & Address:
Contractor
Address:
V
Effective 4/1/84
k
D_ . ,. P.a%;�- Cd / T�%reae%� +��° Tel. #
.vi vvrru
rT107 _ el. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
%�� Width Height
Sq. Ft.
LIVING AREA: Length
GARAGE AREA: Length Width
Height
Sq. Ft.
DECK AREA: Length �_ Width
'� H 8 t/Ground
Sq. Ft . JN'd
OTHER:
91 ed
)&400"4 e �fl
yt
® B ��J 4 �7
4— 9
Corner Lot TE Inside Lot ( J Ft. Yd. Setback Side
Yard Setback
F tdIX
Estimated Cost:
$ a
Type of Construction:
Approx. Completion Date: a6
rt_ Alt. A Alt B
Proposed Driveway Width If New Opening Is
Desired: �� ' $
See Back Page
$
for Explanation
DATE: f�' APPLICANT:_
i05,
Tel.�.f!^/��'�9
CITY
USE ONLY
1
Permit Fee $ �-- � _V
Fee Schedule on Reverse
Side
Plan Check $ '
25% of Building Permit
Fee
State Surcharge $ q
$.50/$1,000 Valuation
SAC Charge $
$425 per SAC Unit
Park Fee $
Fee Determined by Engineering
Sewer Main Charge $
Agreement Necessary ( ]
Not Necessary [ J
TOTAL $ s
STIPULATIONS:
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official
shall, before issuing permits for the erection of any
building or structure, or for any addition to any existing building or structure, or
for any alteration or repair
to any existing building or structure, upon application
therefore, require the payment by the applicant for such permit -of fees to the amount
herein below set forth and
in the manner herein provided to -wit:
Total Valuation
Fees '
r
$1.00 to $500.00
$10.00 (Minimum Fee is $15.00)
$501.00 to $2,000.00
$10.00 for the first' $500 plus $1.50 for each
additional $100 or fraction thereof, to and including
$2,000.
$2,001.00 to $25,000.00
$32.50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraction thereof, to and
including $25,000.
$25,001.00 to $50,000.00
$170.50 for the first $25,000 plus $4.50 for each
additional $1,000 or fraction thereof, to and
including $50,000.
$50,001.00 to $100,000.00
$283.00 for the first $50,000 plus $3.00 for each
additional $1,000 or fraction thereof, to and
including $100,000.
$100,001.00 and up
$433.00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof.
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and
replacement of curb and gutter only - Driveway width plus
6 feet times $13.50
Alternate "B": Removal and
replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth
- Driveway width plus 6 feet times $15.75
VERIFICATION OF FOUNDATION
Permits for construction will
be issued a minimum of 24 hours from the time of
application to allow for
proper review of the proposed structure and of the
construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
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AN7
7W
WIAM
WT.
-40
E-9
iCA SLY 7, -
V� �4
Land planning 6875 M
Land Surveying t. s s �� No. 65 N.E.
Soils Testing !'jl 1.11 70111 tfncs Minn.Minnpolis$
Civi I Engineering 53432
Municipal Engineering Telephone 784-6066
Engineers & Surveyors Area Cede 612
Certificate of Survey for WILLIAM "DICK
--
{
. /
Yt L G
�crL�tC / n (4-
.-A
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i that- piart �nL_ o� t 611rLk i, U.Nt i 6 :=; Ano�ea COLIf�i, ,
in SuuiLhFrf '�
135:0
L1'►Er o'�
l6_LkFr'11r.ce; mta ;acrd ��MthE E�,eri n o'f
I hereby certify that this is a true and correct representation of a survey of the boundaries of the above
described land, and of the location of all buildings, thereon, and all visible encroachments, if any, from or on
said land. As surveyed by me this 19" day of_Ju� A. 0. 19M.
SUBURBAN ENGINEERING, INC.
Engineers Su►I%yor
11 i
CITY qPfRIDLEY INSPECTION DIViSION oo
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 572.3604 . REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent- Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value,of Appliance or Work
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
JOB ADDRESS /
Effective On January 1, 2002
TOTAL
OWNER t ILAV —A—A Jd ! PL -P J
BUILDING USED AS j
$ V�
ESTIMATED COST PERMIT NO.
$
$ .50
$0
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Unit ' Circle One (Steam) (Hot Water) arm Air)
Trade Name f Yl Size No. e
BTU 0, 600 HP EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
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 an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE
, 2h
M
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
IN VENT_ VENT CnNNFCTnR 4Nn CnMRI ISTION AIR VFRIFICL\Tm
When re In acin8 an existing firanr_P, 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.
The venting system is plasbc/PVC and meets all current codes and manufacturer
specifications including sizing, length; number of elbows and termination.
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
The existing rnm6 in ion air is sized and installed to meet the current codes
and manufacturers specifications.
When required to insta0 a new rom6tictien W4 it will be sized and installed
to meet the current codes and manufacturers specifications.
When installing a new venting ny!qfpm, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances.
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.
Appliance #1 Type_
Appliance #2 Type _
Appliance #3 Type _
Total Appliances
BTU Input
® BTU Input
_ BTU Input
Total Btu Input
Yes ( No )
Yes No( )
YesXo
Yes (
Yes No( )
YeNo )
Yes,{ ) No ( )
Fan Assisted or Nat
Fan Assisted or Nat
Fan Assisted or Nat
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
HEATING CO:
Signed By:
Date
Building
BUILDING Permit Ivo.:
Inspections
RESIDENTIAL APPLICATION Received By:
763-572-3604
CITY OF FRIDLEY Date Rec'd:
DATE 1 �6' I ®�
YOUR E-MAIL ADDRESS N -W a CION'"
SITE ADDRESS l
T4 C A4 A,,b-!l E t, ft /u 6 -
THIS APPLICANT IS:
0 OWNER CONTRACTOR
PROPERTY OWNER/
NAME: j,.! CW -G, c,,✓
TENANT
ADDRESS: I (e( _i 4t)AbD ec_ 4"'0-p�' �� .CITY ����� STATFNIZIP�6�WQL
SAC Charge
PHONE:
CONTRACTOR
Curb Cut Escrow
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # EXP DATE
ADDRESS: ��3 OrDowirtj 60. ary Bytk sTATEt&_ lP 55`4,9'
WITH APPLICATION
PHONE FAX 7 &3 " :5 3 1 " 5'5 q
PROPERTY TYPE
SINGLE FAMILYMEW CONSTRUCTION SIZE
$
0 TWO FAMILYMEW CONSTRUCTION STORIES
PERNM TYPE
0 ADDITION 0 GARAGE/SHED 0 WINDOWS
Agreement necessary ( ) Non Necessary ( )
0 BASEMENT FINISH 0 ROOF 13 DRAIN TILE
$ a
DECK O SIDING 0 OTHER
0 SWIMMING POOL
TYPE OF WORK:
.I NEW El ADDITION
AM MAINTENANCE/REPAIR 0 REMODELING
DESCRIBE WORK BEING DONE: PW S;.a!' t +L?- j 1P b 1e a � ;Jsb ®e -j 40 2xC j<
SIZE OF IMPROVEMENT'LENGTH 1 -'WIDTH HEIGHT Sq. Ft
ROOFING
0 HOUSE ONLY
F SQUARES
❑ HOUSE & GARAGE
BASEW- _ REMODELING SUBMIT:
GARAGES
0 ATTACHED GARAGE
I. Existing Floor Plan
2. Proposed floor plan
PROPOSED SIZE:
0 DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
0 Vinyl
OSofflt
ADDITIONS & PORCHES SUBWT:
❑ Aluminum
0 Trim
1. Site Plan(Survey showing the existing structures
0 Other
0 Fascia
and proposed project
2. Two sets of construction plans
PEWS
O
IN EXISTING OPENINGS OYes No LOCATION OF WINDOWS
3' Energy ations
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 $ , 3 2 OCCUPANCY TYPE
Permit Fee
$ - 'I Cl
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$ o
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$ t_
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1675 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
R + 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
$ a
Make checks pgable to: CM of Fridle Attach Sti ,dations
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 permit5drk 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 approval of plans. �J�
SIGNATURE OF APPLICANT PRINT NAME " r'r IC—DATE
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