PRE 2010 DOCSVMage of Fridley,11 um.
BUILDING PERIM
10To 42
Office of WSPECTOR of BUILDWGS
owner
Architect
Frid'ey, Minn.,. 19.
1iuilder
�� s ,
LOCATION OF i3L=ING
No.'
Street Fart o Lot -
>•ot_1
oek� Addition or Sub -Division -
Y�SCIIIaTIOT�T OF BIJILDII�TG
1 rout Dept
I-leight Stories Manner of Construction
To be used as
To be Completed Estimated Cost,t�
s
e e �
, �
f
Permit is hereby
ted to to�
the building.',-—,
described in the:: above statement, This permit is granted
upon the express con
Ition that the;.person to whom it is granted, and his agents, Oployees and workmen, in all
the work done in, a,
and and upo i said building, or any part thereof, shall, conform in ail respects to the ordl-
4ances of Fr diet', 3ybm.,
regarding the construction, alteration.; maintenance repair and moving of buildings
within the city limitE
and this permit may be revoked at any time upon vioiat oti of any of the provisions`of said
ordinances.
Inspector of Buildings.
AGREEMENT AND SWORN STt1M2E1Utll
In considerat
n of the issue and delivery to ane by the InMpector 'of;Buildings of -Fridley of
the above- permit,
"I hereby agree to do the proposed work in, accordance with the description
above set forth ai
d according to the provisions of the ordinance, of Fridley, and, being first duly
sworn, I hereby sl
to and say that the facts stated by me a d'eontained in the above permit are
true as therein stA
ted:
Subscribed and
orn to before me at Fridley, Minnesota, this
day of
7,
k;
•
ir
JP'
M
i
BUILDING PERMIT
NT . --2023
2023
VnIaLre of Fridley, Minn.
'
+..' 4. Z'..
Date tiA
. .
Owner �y.;'
. ... Builder .
Address •, •
•r ..,• r..' •- . r.- Address '. �, , ...... ...... .. .
$�
LOCATION OF BUILDING
No.—. 71, .��,�°
...... .
Street :. a , .:,W 6",. y� . Part of Lot
Lot ....
Block ... Addition or Sub -Division .. . .... ............
Corner. Lot
. Inside Lot Setback Sideyard
DESCRIPTION OF BUILDING
To be Used as:
Front Depth . e '. ITeight Sq. Ft......... Cu. Ft. .. . .
........ , ......
Front Depth ........ Height .... Sq., Ft......... Cu. Ft....'.... .
F.a:
Type of Constructi
.s Est cost ... :.rrm ...... To be,Completed
b
In consideratio
I
" of the. issuance .to me of a permit to construct the building' described above, I agree to do
the proposed work
accordance with the description above set forth, and in compliance with all provisions of
ordinances of the v
age of Fridley.
o •... p 1
7n consideratio4
.............. .
of the payment of a fee of .$ or. • :", permit `is hereby granted to .........Is
...:......:....
the express conditi
to construct the 'building or addition. as described abode. This permit granted upon
that the person to whom it is granted and his agents, employees and workmen, hi all.work
done in, around an
upon said building, or any part thereof, shall conform in all, respects to the ordinances. of
Fridley, Minnesota
Pegarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limit-:
and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
- Building Inspector
t'I
NOTICE:
This permit
does not oover the oonstruCtiOn,t installation -or alteration for wiring, plumbing, gas heating,
sewer or water.
Be sure to see` the Building lnspeotor for separate permits for these Items.Il
M
City of Fridley
r AT THC TOP OP TME TWINE
tL'"'^'COMMUNITY OEVELOPMRNT QIY,
PROTECTIVE 09ftCT10N WT.
CITY HALL FMCLSY `$Olt
53-81,-S-915.51
PLUMBING, PERMIT APPLICATION
Job Address 0 12115/73 1 1 1 1 800
7570 N. r. Van Buren Street
Owner Dale Swnson Address Phone
i
Contractor Address Phone
MINNEGASC® 713 MARQUETTE AVENUE
Kind of Building Use , MINM
Frame Res.
Completion Date Estimated Cost
12-26-71, .10,00
i
lm
I�
.O o
i�
I - 3 o - 76
M
O
s
3
t
1 Plumbing Fixture Rates: NO.
i -
RATE
TOTAL
, ! Number Fixturesx
$2.00_
Future Fixtures x
$1.50
New Fixture -Old Open. x
i
$1.50
Catch Basin x
i
$3.25
Water Heater -99,000 BTU x
I
$3.00
Ground Run Old Bldg. x
$3.25
Elec. Water Heater x
$2.00
Gas Fitting Fees:
lst 3 Fixtures x
$2.00
I -
' Additional Fixtures x
$ .75
i
Gas Range -199,000 BTU x
$5.00
Repairs & Alterations
See
Description: Install Dryer Code
5.00
State Surcharge Class �e Sor-chsrg-e m50¢
.50
l TOTAL FEE
$
5.50
,The undersigned hereby makes application
for a permit
for the work herein specifiedo agreeing
to do all
work
in strict accordance with the City Ordinances and
rulinj
of the Department of Buildings, and hereby declare that
all'the facts and representations stated
in this
ap lication are true and correct.
6�+A�
'Signatur�ll NFrAcrA
Date
t
No OrAlmew'k-y-N Ccss-zfmg've-m-'ImFem" Eld"'u", aaj
X.Jr S.... &,-A Devhw—
P
MA TnT TVAPM AIM: RATE TOTAL
vmwce she'a a Dud 7e�ZA .. .. ..
RGplacement of Y=ace 6.00
;repairs & Aherations—up tt-3 6.00
or NOT VAT9M 5787M
17'i-,rnace SheU & Lines --to 4M 2q. ft. ZDR Stewn $10.00
Furnace Shell & Line—to 640 sq. ft. EDP Hot Water 20.00
Each add. 200 aq. ft. ZDR Steam un
Each add. 320 sq. ft. ZDR Hot Water 3.00
a
City ad Fdalay.
The umdezoignn-,4 h "-eby n, a—l-es appUeag(aa 26? a permit fow the Wo� hareb,
specified, agireeing to do all work in strict Agoardance with he City
MRd ruhr,� of the Department ®i Buildings, aid hereby dezlzrnz-, Lhant &31 n, c -
and representations stated in this appIketion are euuZ oczz-zzt
Fridley. Man -
Owner
Kind of Building.—
Used as
To be eomp:leted =abo t
Estimated Cost,
(9LMW. BUMAMS P A-40. permit No
97-8b-879001
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
%:%=.ber Fixtures
x $3.Q0
$
i ut6:re Fixture Opening
x $2.00
$
New Fixture, Old Opening
x $2.00
$
Catch Basin
x $5.00
$
:rater Heater - to 99,000 BTU
x $5.00
m
1',0,000 B7U to 199,000 BTU
x $10.00
$
a
x $7.00
$
New Ground Ran Old Building
x $5.00
$
k
0
$
Water
o
m
41
n
.-�
o
E.
r
Additional Fixtures
Id
54
E
C-
..r es
0
$4
Q
y
'�ro H
a
w
�
$5.00
Heater
H
0
Q
State Surcharge
G
M
TOTAL FEE
X :W
U
W05
fJ
R:,
►1
0
Lt O
++
is
t1
G
N
••� 0
O
8
41 t7
N
to
N
N
x
u
«s -4
rU
5
ro.�
r-
d
ai
3
ow
y
w
ewar
ro
0,ro
8
�+
0
as
lec
} 1s _
2ne
3xd i
�
I
4t,
(R) a F,:ture Connection Opening
Connected with Sewer
(') New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
%:%=.ber Fixtures
x $3.Q0
$
i ut6:re Fixture Opening
x $2.00
$
New Fixture, Old Opening
x $2.00
$
Catch Basin
x $5.00
$
:rater Heater - to 99,000 BTU
x $5.00
$
1',0,000 B7U to 199,000 BTU
x $10.00
$
Hater Softener
x $7.00
$
New Ground Ran Old Building
x $5.00
$
Electric Water Heater
x $5.00
$
GAS FITTING FEES:
1st 3 fixtures
x $3.00
$
Additional Fixtures
x $1.00
$
Cas Range to 199,000 BTU
x $10.00
$
REPAIRS & ALTERATIONS
First $100.00
$5.00
$
each add. $100.00 or fraction
$2.00
$
State Surcharge
$ .50
TOTAL FEE
$ 8•
REINSPECTION FEE
010.00)
Job Address 7570 NE Vara Buren
Department of Buildings
City of. Fridley
Tel. #571-3450
The undersigned hereby nakes application for a permit for the work herein
specified agreeing to do all work in strict accordance with t -he City Codes
and rulings of the Department of Buildings, and hereby declares t1hat all
the facts and reprosentations stated in this application are true and correct
Fridley, Mn. 10-9-80 , 19
OWNB- R BROOKS
KIND OF BUILDING frame
USED AS res.
TO BE COMPLETED ABOUT 10-16-80
ESTIMATED COST 50.00 /
OLD - NEW BUILDING PERN.IT NO. PERMIT NO. �y� G
company gyw- o _
Signed By MI-NINEGA-cm
Tel. No.
ROUGH INSP.
Date
FINAL INSP. 4 -9/
Date
APPROVAL FOR PMXIT �
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURC:MRGE
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SUBJECT
City of Fridley
26840
AT THE TOP OF THE TWINS
?
BUILDING
P E R M I T
r
1
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
NUMBER
REV
OATE
PAGE OF
APPROVED BY
1 "1 CITY HALL FRIDLEY 55432
IL"-"
612-571-3450
910-F15
7/27/98
JOB ADDRESS
7570 Van Buren St
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
10
2
1 Shaffer's Subdivision No.
1 SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Tabor & Sons Inc7R()-19n2
20()1421LA
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
❑ NEW ❑ ADDITION ❑ ALTERATION jp REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof 18 Sq.) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
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
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1501
$.75
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.
$51.25
Fire SC $1.50
PLAN CHECK FEETOTAL
FEE
11 /,
License .
00
8.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
N P PALIDATED
T IS IS YOUR PERMIT
Y r
BLDG jWNSP
Ar
MATE
SIGNATURE OF OWNER pF OWNER BUILDERI IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R -2o
BUILDING PERMIT APPLICATION
ConstructionAddress: 75. 7 0 B
Legal Description:
Owner Name & Address: 7S 74 fja,4 Tela #
Contract
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
GARAGE -AREA: Length
DECK AREA: Length
OTHER:
DESCRIPTION OF E%IPROVEMENT
Width
Height
Width
Height
Width
Hgt/Ground
ENSE #Z? p O f "' 2 z/ Z
Tel. # 2:F S_ - / 91c, ,2
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: A -e � 1�-
� Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: 7-22- '� e"PLICANT:
� �a2�z� Tel. # 2 g 'j-- d 9 a Z
CITY USE ONLY
Permit Fee
$ %�
Fee Schedule on Reverse Side
Fire Surcharge
$ S O
.001 of Permit Valuation (1/10th%)
State Surcharge
$ %
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$ ,�, 00
$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 [ J
TOTAL $ O-S'D
STIPULATIONS:
t
BUILDING PERMIT FEE-SCBEDULE
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 Fee is $21 plus surcharge)
$501 to $2,000 $21 for first $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
$100,001 to $500,000 $887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000. $2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 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 it has been constructed
will be required before proceeding with the framing.
CITY..OF FRIDLEY INSPECTION DIV.
6431 University Ave NE �
Fridley, MN 55432 1 LD b APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
763-572-3604 `
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
i€...... t:: Wash
iomgi*'.**iiiiiiiiiiiiiiiiiFloor
- ...
.....
--...
::::::::_ Auto.
lip"
Stories Urinal Tray Drain
Washer AMl
Basement
Floor 1
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES
New Fixtures .
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas**
Gas Range"*
Gas Dryer** _
Back Flow Preventer Required ( )Yes () No
Type
RATE
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
TOTAL JOB
Effective On Jan 1, 2001
Gas :: Water Heater
Ran e
<��' Gas Elec
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 Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
Z?l E i E C �?_ —� 202C
Owner U L CoL�
Building Used As
7
Estimated Cost PERMIT NO. o
PLUMBING COMPANY (SA C ��04 [ *`
SIGNED BY TEL N0.
Approved BRough-In Date Final Date
�IP;s 4J 11 _11�.'...'.
$ .50
MINIMUM FEE OR ANY PLUMBINGIGAS PERMIT IS $20.00
PLUS THE $.5� STATE SURCHARGE
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 ( ) 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 installina 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
CIiYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
January 11, 2002
Ms. Nicole Ciereck
7570 Van Buren St NE
Fridley, MN 55432
Re: Final Inspection at 7570 Van Buren St NE
Contractor: Shiloah Water Co.
Dear Ms. Ciereck:
A plumbing permit was issued on February 5, 2001 to install a water softener at
your address. According to Section 4715.2800 of the State Plumbing Code, a final
inspection shall be conducted on the work authorized by this permit. As of this date,
no final inspection has been called for.
The permit fee that was paid covers the inspection to make sure the work was
completed according to the Code. We will keep your permit open for another 30
days and if we do not hear from you within this time to set up the inspection, we will
mark the permit "no inspection called for" and take no further action.
To set up the inspection or to have any questions answered, please contact the
Building Inspection Division at (763) 572-3604.
DJ/mh
Building
BUELDING
Plan Review
Permit Rio.:
Inspections
RESIDENTIAL "PLICATION
Surcharge
b,_
763-572-3604
CITY OF FItII)LEY
SAC Charge
Date
DATE 09/08/10 YOUREmAILADDRESS esttjerdawindowworld n.com
srm ADDRESS 7570 Van Buren St NE
Erosion Control
THIS APPLICANT IS: 0 OWNER OCOATTRACTOR
Park Fee
PROPERTY OWNEW
NAME: Dominico Cao
$
TENANT
ADDRESS: Same aS site CITY
STATE ZIP
PHONE:
CONTRACTOR
NAME: ProBuilt America
SI.BhUrAOOPYOF
STATELICENSE# BC -20356847 EXP DATE 03/12
2211 11th Ave E
55��
YOUR. STATE LICENSE
ADDRESS: CITY North SVA STATE ZIP
Wrim APPLICATION
PHONE 651-770-9325 FAX 551-770-0495
PROPERTY TYPE
9 SINGLE FAMILYINEW CONSTRUCTION SIZE
0 TWO FAMILYMEW CONSTRUCTION STORIES
PERMIT TYPE
0 ADDITION 0 GARAGFISHED @+WDMWS
0 BASEMENT FINISH 13 ROOF 0 DRAIN TILE
0 DECK 0 SIDING 0 OTHER
0 SWIMMING POOL
TYPE OF WORIQ
0 NEW 0 AMMON
0 MAINTENANCEMEPAiR 0 REMODELING
DESCRIBE WORK BEING DONE: Replacing 10 window, existing openings
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. FL
Boom 0 HOUSE ONLY
NUMBER OF SQUARES 0 HOUSE & GARAGE BASEMENT
REMODELING SUBMIT:
1.
❑ ATTACHED GARAGE 2.Pmposed
Eidsfing Floor Pian
firm, plan
PROFOSTID SIZE: 0 DETACHED GARAGE 3.
List ofSttt WW m®miara to tensed
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
11 Vinyl DSoffit AA>3r'rM,
Be Pt)1tc= MTRAgr7':.
0 Alu idnam 0 Trite 1.
Site PIMMUrvey AMvatg the oxistatg structs M
ElOdw O F
WWPMPMdPMjQM
2.
NENUSWS
Two Seta of motion PIM
IN EXISTING OPENINGS Oyes Olin LOCATION OF WINDOWS 3.
Energy Calor
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES & 1 �
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINT�WS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS;
(USING THE 1937 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 4170 OCCUPANCY TYPE
Permit Fee
$ B L t A
Plan Review
$
Fire Surcharge
$ c
Surcharge
b,_
Lice Surcharge
$
SAC Charge
$
Curb Cut Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge
$
Total Due
$ r- C
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation RRinimum $.50
$5.00 (State Licensed Residential Contractors)
$1675 per SAC Unit (Plans to MG/CC for determination)
ft+6ft= ftx$2I=$
$450 Conservation Plan Review
Fee Determined by Engineering
Amt necessary ( )Rion Necessary ( }
THIS IS AN APPLICATION FOR A PERMiT.NOT VALID UNTIL lL PROCESSED
Attach
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 Fridky and With the Minnesota Construction Codes; that I ward Oris is not a
permit but only an application ion 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 work which requires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME Esther Dahl DATE 09/08/10