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PRE 2010 DOCSCHIM14EY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; 1. Has been carefully examined Yes No 2. Is free from rust or deterioration Yes No ( ) 3. Has no foreign objects lodged within Yesff No ( ) 4. Is securely supported Yes ;o No ( ) 5. Meets all current Code requirements for size and total BTU connected Yes No ( ) 6. Has Total heating BTU's of All other BTU's TOTAL Remarks Company l� Signed By �^ Date �(' AHVIU L.UAKLSUN U SON INU. 3200 FRANCE AVE. SO. C) 5rd. STREET N. E. In oD 6 FS "10 �07 5044 II h /A 'ji L,,2 La W a -L I 25 26 27 tic e: 24 --70— a9 40 23 22 21 LANE 7f 4 16 .509 r4 15 17 14 12 ji 1 10 0840. . .. —, T7077671 504 507 19 Ar Ja T 1l ni 402 21 CLEARVIEW IUSP T R E E T PERMIT NQ City of FridleyP. 125suBdECT AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. `L _ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-1715 6/5,/74. JOB ADDRESS 5060 Topper Lane N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 20 5 1 Carlson's Summit Manor South Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Marvin Nunemaker 5060 Topper Lane n.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Bill;s Millwork 4 Walnut Street Savage, Minnesota 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 9 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 13.5' x 13.5' Addition to back of dwelling 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. Wood Frame 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 R-1 182 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 $4,500.00 2.25 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. $27.00 PLAN CHECK FEE TOTAL FEE ,v-1-`7 $29.25 ' SIGNATURE& CONTRACT R a AUTFf RIZEDAGENT (DAT EN P OPERLY VALIDATE DXN S I YOUR PVMIT Q SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) DG. INSP DATE APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDI'T'ION BUILDING PERMIT C f TY OF F R I DLLY , MINNESOTA OWNER'S NAME •��/��//l elle%�%r�%1e BUILDER : ADDRESS _1_6(S6 1AjILe ADDRESS 4f lokl�/ti STREET: Le&&� 10t 1,4 � � r LOT:, lT _BLOCK; ADDITION CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed buildirig location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: � j q(d.� Front. Depth: 0' _Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost: $ 7 0 To Be Completed: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stticL accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that .i11 the facts and representations stated in this application are true and c orrve t . DATE: S WNATURE: (See Reverse Side For Additional Information.) R CCK e oo_ .41 CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Furnace Shell and Duct Work, Burner (Also replacement furnace) Gas Piping (piping needed with new furnace) Gas Range Gas Dryer * Air Conditioning (all sizes) All Others/Repairs and Alterations 1% of Value of Appliance or Work. COMMERCIAL/INDUSTRIAL 1% of Value of Appliance or Work RATE TOTAL $ 20.00 $ $ 10.00 $ $ 10.00 $ $ 10.00 $ $ 10.00 $ 10.00 State Surcharge $ .50 TOTAL FEE $ 15.50 Reinspection Fee ($15.00) �0 $ Rough Insp. Date Final Insp. Date Approval for Permit Job Address 5060 Topper Lane NE Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. ,Tune 2 19 88 OWNER Marvin Nunemaker KIND OF BUILDING Frame USED AS Residential TO BE COMPLETED ABOUT ESTIMATED COST $1600.00 OLD - NEW BUILDING PERMIT NO. PERMIT NO. �y(Q DESCRIPTION OF FURNACE/BURNER **INSTALLING ONE (1) CARRIER 38EHO24/24 2 TON AIR HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. CONDITIONER**** Trade Name Size No. MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00- PLUS 15.00PLUS $.50 STATE SURCHARGE Attach stack verification form with. replacement furnace permits *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. Capacity Total Connected Load BURNER - Trade Name Capacity Sq. Ft. EDR BTU HP Kind of Fuel Size No. Sq. Ft. EDR BTU 'jHP Company d_ OL Signed B �+� p a' Tel. No.—�t OF SUBJECT0. City of Fridley 2 4 9 6 3' AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. &46,,j CITY HALL FRIDLEY 55432 NUMBER REY DATE POF AGE APPROVED BY 612-571-3450 910-F15 3/21/97 JOB ADDRESS 5060 Topper Lane NE I LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 20 5 Carlson's Summit Manor South Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. SMA Inc 810 Lilac Drive, Golden Valley MN 55422 521-0627 20042927 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 House & Garage, 18 Sq, Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Install smoke detectors to meet the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 1 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 $1,485 $.74 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- $48.50 Fire SC $1.48 TRUCTIO HE PERFORMANC/OF ONSTRUOVON. PLAN CHECK FEE TOT L FEE Licenselc $5,00 $55.72 SIG URE OF CONTRACTOR T Ri DNT (DATEi ROP VALID THIS IS YOUR PERMI , %� SIGNATURE OF OWNEROF OWNER BUILDER) iDATEi BL iNSP OA TE OF NEW [ ] ADDN [ ] ALTER [ ] ConstructionAddress : Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 .. BUILDING PERMIT APPLICATION � X60 >" z Effective 1/1/97 Owner Name & Address: Tel. # Contractor: ��) MN LICENSE # GD qV-!I Address: �S% Cj ��— r' 8 Tel. # %' 0 �oZ 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: n With Hgt/Ground Sq. Ft - OTHER: = 1� CN 16 L. Construction Type: A O Estimated Cost: $ (Fee Schedule on Back). Driveway Curb Cut WidthNeeded: Ft. + 6 Ft Ft x $ 77 v 1. DATE:, 1- APPLICANT: Tel. # - STIPULATIONS: CITY USE ONLY Permit Fee $ q&,O Fee Schedule on Reverse Side Fire Surcharge $ a .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge $ 06 $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: 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 VALUE FEES $1.. to $500. $21 (Minimum Feeis $21 "plus surcharge) $501 to $2,000 $21 for fust $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $62.25 for first $2,000 plus $12.50 for each additional -$1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $LOW or fraction thereof j 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 it has been constructed will be required before proceeding with the framing. I / SUBJECT c City of Fridley AT THE TOP OF THE TWINS B U I L D I N G P R M I T 32124 r • _____ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. 672®3s r � � PROTECTIVE j co NUMBER NEv DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/31/01 JOB ADDRESS 060 To er Lane I LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 20 5 Carlson's Summit Manor South Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mary Nunemaker, 5060 ToRper Lane Fridley, MN 55421 763-572-8717 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Franzen Construction, t 1. Hts— MN 55421 763-788-4071 2744 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 1 NEW O ADDITION O ALTERATION O REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Construct new garage. 9 CHANGE OF USE FROM TO STIPULATIONS REQUIRED FOR: See notations on plans. WIRING, HEATING PWMBING AND SIGINS WARNING Before digging call foF all utility locations 454.0002 REQUIRED BY LAW 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 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 $9,907.48 r $4.95 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 TATE OR LOCAL LAW REGULATING CON- ire SC $9.90 ST N OR THE P FO NCE OF CONSTRUCTION 1,81,.25 PLAN CHECK FEE Lice ns 5.00 TOTAL FEE 201.10 SIG ATUAEFCONTRACTORORAUTI IZEDa AGENT I I ATEI HE PROP VALI A D THIS IS YOUR PERMIT BL INS — gArE S-GNATURE OF OVVNERIIF OWNER BUILDERI IOATEI�� I / NEW [] ADDN [ ] CITY OF FRIDLEY ALTER [ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: Effective 1/1/2001 (763) 572-3604 Bldg Insp =i 01 0( Owner Name & Address: /%,honV Tel. # .S7Z- g9'7/ % Contractor: oari»t,n M04 e. MN LICENSE # 7V51 Address:_ P,/? --5 zsr-'`-e' Tel. # W -"e l 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. t, GARAGE AREA: Length ZZ ' Width G`vZ 'f Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type:Estimated Cost: $ ®r� Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ 01 DATE: G"'T d APPLICANT: Tel. # O O CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application $ 181 ;?,5 -Fee Schedule on Reverse Side $ 9.90 .001 of Permit Valuation (1/10th%) $ $.50/$1,000 Valuation $ $1150 per SAC Unit $ 00 $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 [ ] 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 VALUE FEES $1 to $500 $23.50 $501 to $2,000 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000,. $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 to $500,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $500,001 to $1,000,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $1,000,001 and up $3,608.75 for the first $1,000,000 plus $3.15 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 $15.50. 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 $23.25. 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 it has been constructed will be required before proceeding with the framing. New Houses Only 1411F. �s Building BUILDING Permit No.• Inspections RESIDENTIAL APPLICATION. OCCUPANCY TYPE Received By: - 763-572-3604 17 :1See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee CITY OF FRIDLEY $ Dat • U ZQO 763-502-4977FAX $ '2.'06 .0005 x Permit Valuation Minimum $.50 License Surcharge $ EFFECTIVE I -1 -os SAC Charge $ -7 / • D_ Curb Cut Escrow DATE ! • IP YOUR E-MAIL ADDRESS ft + 6 ft = ft x $21= $ SITE ADDRESS .5_0 6,0 �OZ04� `YI SP, $ THIS APPLICANT IS: 0 OWNER CONTRACTOR Park Fee PROPERTY OWNER/ NAME: 7ldJr. 4A;V � _ Sewer Main Charge TENANT ADDRESS: , & 0— "4L14 L-, 77�5 CITY STATAV• ZIP $ PHONE:C?��S7a - F'W 17 .95 NAME: 00re IP riot CONTRACTOR �� ADDRESS: 7 4 Zht _ tp CITYSTAT)E�I� ZIP SSQ l SUBMIT A COPY OF PHONE C Sl ' 6,4( FAX YOUR STATE LICENSE STATE LICENSE # / `I IW DATE ✓,0 / PROPERTY TYPE SINGLE FAMILY SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE 0 ADDITION ❑ GARAGE/SHED 100WINDOWS ❑ BASEMENT FINISH 0 ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION PrMAINTENANCOREPAIR. 0 REMODELING DESCRIBE WORK BEING DONE: —PLO SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT OFFING 0 HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BAST REMODELING SUBMIT: GARAGES ❑ATTACHED GARAGE 1, . 2. Existing Floor Plan Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Som ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim I. Site Plan/Survey showing the existing structures 17 Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS ,/� IN EXISTING OPENING&4ff?cs ❑No LQ�A pN� 3. Energy Calculations IOF-WINDOW OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF. WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALJ, rZra nccn; DAMW VA VALUAIWA, D CLUDOG THE COST OF LABOR AND MATERIALS: (USG THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ Q OCCUPANCY TYPE Permit Fee $ C4 17 :1See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ 77. OQ .001 times the total job valuation Surcharge $ '2.'06 .0005 x Permit Valuation Minimum $.50 License Surcharge $ '5-"00 $5.00 (State Licensed Residential Contractors) SAC Charge $ $1825 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 $ Make checks payable to: City of Fridley Attach 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 th4 Minnesota Conduction Codesqfbat 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 will in cc wi ev plan in the case of all work which requi review nd appr v of lana. y SIGNATURE OF C PRINT NAME �'✓� DATE /' l APPROVED BY �� --� DATA% A�0 9 J�