PRE 2010 DOCSCity of Fridley, Minn.
:BUILDING PERMIT N® 3257
Date: ...... r �.
... .................
Owner....................................... Builder e(.A} .....::................. .
:Address ...................................... Address ............................................
N0.48LOCATION OF BUILDING
I... Street...:`..:¶.:":......... �n........ Part of Lot............. y .........
Lot .....c.... Block .:.......... Addition or Sub -Di inion _h
M �.... .....
Corner Lot ............ Inside Lot ............ Setback :�� ...... Sideyarrl.......... .
DESCRIPTION OF BUILDING
To be Used as.
`....
...::
�.:
Front
Depth X Height ... ..
Sq. Ft. :� .�1 Cu. F`t.
...................
Front ........
Depth ........ Height
. ....... Cu. .......
Type of Construction
"-
�
Cost.. r' . ........
M:
To be Completed . l.. 7:-:........... .
{ e
t7:r
ar
tit a
A.d` P1�.4__,¢�_-�' E.r_.A° 1 + 1'-• r rip
In consideration of the issuance to me of a permit to construct the building desribed above, I agree, to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
....................................................
�, F=
In consideration of the payment of a fee of $ ..., 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 with-
in the city limits and this permit may be revoked ' at any time upon violation of any of the provisions of said
ordinances.
`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• +foe -separate permitsyfor these Items.
W-- -4:V411-4
City of Fridley, Minn.
BUEWING PERMIT N? 7483
Date: 1by 21, 1965
Owner: Arthur Evaocelist Builder Giertsen Co.
Address 6M WT hington St. NeR. Address 3501 %ndwood Ave.
LOCATION OF BUILDING
No. 6871 Street _Washin on St° KbEo _.. Part of Lot
Lot _ 3 _.._ Block _ _3 Addition or Sub-Divtsion�Ce Cresk Terrace Plat 6
Corner Lot Inside Lot Setback __ _ Side -yard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front Depth Height Sq. Ft Cu. Ft
Front Depth Height Sq. Ft Cu. Ft
Type of Construction Est Cost — _____ lt__ To be Completed
Repair storm damage
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 all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $_ __._, , permit is hereby granted to
to construct the building or addition as described above. This permit is granted upon
the :In,
press condition that the person to whom it is granted and his agents, employees and workmen, in. all work
done Fridy, iVtinnesota regardiYg location, construction, alteration, maintenance, repair and moving of buildings
within the dty limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Building Inspector
NOTICE:
Tlds perp& don not corer the eonstrueflon, installation for whbg, plmblng, gas beating, s wor or water. Be acre to res
the Boildhtg hopeaer for separato permhs for those ham
,..APPLICATION FOR BT A"ING - PERMIT
CITY OF FRIDLEY 0 'LMSMA
No. street Part of Lot.
Lot Block or Subdivision
Corner Lot Inside Lot -SetWatk Side -Yard
SEWER ELEVATION FOUNDATION MXVVUON
Applicant attach to this form Two Certificates of. Survey of Lot and proposed build-
ing location driva on these CA-ftificates.
DESCRIPTION OF BVILDINC
To be used as:
Front Depth Height,
Sq. Ft. Cu. Ft.
Front Depth
Height.
Sq. Ft. Cu. Ft.
Type of G(nstruction Estimated, Cost;//,
The undersigned hereby makes application I for apermit.,for the work herein specified*,,
agreeing to do all work in strict accordance w . ith 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.
-0cledule of, Fee Goats can be found on the Reverse Side).
City of Fridley, NUmn. ® 9342
BUILDING PERMIT JY:V,,V--
Date: June 28, 1967
Owner: Arthur J. Evangelist Builder Same
Address 6871 Washington M. St. Address Same
LOCATION OF BUILDING
No. 6871 street , washingtgn St. --- Part of Lot
Lot — 3 --- Block 3 Addition or Sub -Division ._.._Rice Creek Terrace, Flat 6
Corner Lot Inside Lot — X Setback —... Sideyard
Sewer Elevation
To be Used as:
Garage' Front
Foundation Elevation
DESCRIPTION OF BUILDING
20' Depth 22' Height 10' Sq. Ft. 440 Cu, Ft 4400
Front Depth Height . _ Sq. Ft Cu. Ft.
Type of Construction Wood Frame Est Cost W_�900000 To be Completed . , Sept. 1967
In consideration of the issuance to me of a permit to c
the proposed work in accordance with the description above
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 7.00
I above I agree to do
with ,ail provisions of
hereby granted to Arthur J.
Eyangelist 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 buildin�a
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
CLARENCE BELISLE Building Inspector
NOTICE:
This permit does not cover the construction, lustagelton for whih+g, phnubing, gas heating, sower or water. Be sore to iso
the Building hupector for separate permits for those items.
AI'?1MCM'1rj a FOR BMILD `NG
o�
Cs t:i OF I'RrM2Z,, MM'ZIiT:SOTA
OWNER'S NMJF.87/111,,� fi`JtIZERl rr
ADDRESS�51X_.s� _ �'� ADDRESS
LOCATION OF BUILDING
No • �7 -- STREET PART OF LOT
LOT .3 BLOCK 3 ADDITION OR SUBDIVISION 07/C6_
CORDER LOT INSIDE LOT X/ 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 Ad
P, Front 2 Depth Z! 2- Height '
Sq. Ft. Cu. Ft.
_Front Depth Height
Sq. Ft. Cu. Ft.
.oa
Type of Construction Uj o o C2 ) P A M a- 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.Buildir_gs, and hereby declares that all the facts
and representations stated in this application are true and correct.
DATE SU v �9� SIGNATUF.E
(Schedule of Fee Costs can be found on the
MIN,
ENGINEERS AND 8URVEYORS
LAND 13URVEYINO SOILS TESTING
CIVIL &. MUNICIONL. ENOINEEIZING LAND PLANNING
6418-5ro'rl' AVENUE N.
MIwwEttlPc)LI5 TL MILAN.
KE 7- 1�637
fn7
V
NS
I lx�N
A.
V
. WE HEREBY CERTIFY TH-Nr THIS IS N TRUE AMC) CORRECT PLPRESENTNTIOM OF P, SURVEY OF THE BOUNDP,R.IES OF THE
LMD PZOVE DESCRIBED AND OPTAE LOCNI'loN OF ALL BUILDINGS, IF -TREIREON ;P -4D NLL VISIBLE NCRONCIAMEMTS,
IF ANY, FROM OP- ON SATO LAND, MINDIER ENlGt1lllEE1ZlNCi CO.., INC
WED THIS VP"r M E t-4 cl 04 F f
t'y
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287
June 1, 1999
Judy Bittner
6871 Washington Street NE
Fridley, MN 55432
Re: Final inspection at 6871 Washington Street NE
Contractor: River City Sheet Metal
Dear Ms. Bittner:
A mechanical permit was issued on June 1, 1998 for the property located at 6871
Washington Street NE for a new furnace and air conditioner. According to Section
305(a) of the 1991 Uniform Mechanical Code a final inspection shall be performed on
the mechanical permit. As of this date no inspection has been called for.
You will be given thirty (30) days from receipt of this notice to respond. If we do not
hear from you, we will expire the permit and any inspections on this installation will
require a new permit.
Any questions can be addressed to myself at (612) 572-3603.
Sincerely,
Bary Riesch
Building Inspector
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditioning — All Sizes
All Others/Repairs & Alterations (UST ON BACK
1 % of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Effective On January 1, 1997
ti
State Surcharge $ .50
TOTAL FEES$ S 5 o
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Burner Trade Name
BTU
HP
Size No.
EDR
HEATING COMPANY ��UCO LSM �YL ftf0
Signed By Lam' Tel No.��'
Approved ByRough—In Date Final Date
ell
FILL OUT BACK SI4FSTACK VERIFICATION ON
REPLACEMENT FURNACE
JOB ADDRESS 871)ffir.nraiynf�
The undersigned hereby makes application for a permit for the work herein
Rate TOTAL
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
$ 30.00
representations stated in this application are true and correct.
$10.00 $
OWNER. (AdIl &JkEP_
$10.00 $
BUILDING USED AS
$10.00 $
�+1
ESTIMATED COST PERMIT NO.
$ 25.00
DESCRIPTION OF FURNACE AND OR BURNER
$
No. of Heating Units Circle One (Steam) (Hot Water) arm Ai
Trade Name T�'Y1 �}_ Q.� Size No.
BTUHP EDR
$
Fuel Total Connected Load
State Surcharge $ .50
TOTAL FEES$ S 5 o
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Burner Trade Name
BTU
HP
Size No.
EDR
HEATING COMPANY ��UCO LSM �YL ftf0
Signed By Lam' Tel No.��'
Approved ByRough—In Date Final Date
ell
FILL OUT BACK SI4FSTACK VERIFICATION ON
REPLACEMENT FURNACE
Remarks: .
List ALTERATIONS Being Done: '
HEATING CO:
Signed By:
Date:
—r((Y
CHDaNEY AND STACK VERIFICATION
The
undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
Yes (P'-J'No ( )
2.
Is free from rust or deterioration
Yes (vj No ( )
3.
Has no foreign objects lodged within
Yes (t No ( )
4.
Is securely supported .
Yes (t -)""No ( )
5.
Meets all current Code requirements for size
Yes ( )
and total BTU's connected
(4No
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7.
Has a liner been provided for water heater
Yes (O"'No ( )
8.
Has combustion air been provided for water heater
Yes (q No ( )
Remarks: .
List ALTERATIONS Being Done: '
HEATING CO:
Signed By:
Date:
—r((Y
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS
New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein
Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin $ 7.00 and representations stated in this application are true and correct.
Catch Basin $ 7.00
Rain Water Leader $ 7.00 , 202—
Sump/Receiving Tank $ 7.00
Water Treating Appliance $10.00 Owner
C2 JSj -e—
Water Heater -Electric $ 7.00
Water Heater - Gas** $10.00 Building Used As K eSLCQFd�jC-_t-
Gas Range** $10.00.
Gas Dryer** $10.00 Estimated Cost _ PERMIT N0.
Back Flow Preventer Required ( )Yes () No ��'
Type $15.00 PLUMBING COMPANY C
Reinspection Fee $47.00/Hr SIGNED BY TEL NO.'! tQa
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS �91 p FAX #
1.5% of Value of Fixture or Appliance
ApprovAByRough-In Date Final DateState Surcharge .50MINIMANY PLUMBING/GAS PERMIT IS $20.00
TOTAL FEE $ PLUS THE $.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
COMMON VFNT. VENT CONN .TOR AND COMR11STInN AIR <r=R1FI ATInN
When re la _ing an existing fi trance, 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 Pxosting combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes( ) No( )
When required to install a now rnmhiistion air. it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes( ) No( )
When installing a new venting syr , 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 #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
HEATING CO:
Signed By: Date
CITY OF FRIDLEY PERMIT .: 004-00723
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 2004
572-36U4 N'A.2L: (763) 571-1287
ADDRESS : 6871 WASHINGTON ST NE
PIN : 143024120042
LEGAL DESC : RICE CREEK TERRACE PLAT 6
: LOT 3 BLOCK 3
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOW/DOOR REPL
VALUATION : $ 5,000.00
NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317
OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS.
REPLACE WINDOWS WITHIN EXISTING OPENINGS.
STATE LICENSED CONTRACTOR 1
APPLICANT
GRAYHAWK BUILDERS (20174611)
3020 CENTERVILLE RD
LITTLE CANADA, MN 55117
OWNER
DELANE LEVINE
6871 WASHINGTON ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
011-01 to
BUILDING PERMIT FEE
111.25
FIRE SURCHARGE
5.00
STATE SURCHARGE, VALUE
2.50
LICENSE SURCHARGE
5.00
TOTAL
123.75
PAID WITH CHECK # 13029
D�rr� 1 n rnivvu t a r vl\ YY vlvl v i ru:.n 1 i 1ru'l LL u�.iu�LL r►uv r u.
A1J15-r-- 2C -u31 11: 41 FRG I CITY OF FR I DLE ;' TO
NEW � 1
ADDN !I
ALTERCITY OF FRIDLE`d
�) MGLE FAINTLY AND DUPLEXES R-4 AND R.2
BUILDING PERMITAPPLICATION
t -514b I P. 01.'02
EffecSve 'Uv24o7
(763) 672-36" EMS Insp
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LMNG AREA: Length Width Height Sq. Ft
GARAGE AREA: LenW Width Hest Sq. Ft
DECK AREA: Length Width Hgt/Ground Sq. Ft
OTHER:
;onstrUction Type: ( (� .d Estimated Cost: $
veway Curb Cut VWdth Needed: _Ft + 6 Ft = Ft x s = $
ATE: a301 APPLICANT: Tel.���
TY USE -ONLY- Call (763) 572 -UN for PerWit T=ees it mailing in application
ermit Fee $-111Fee Schedule on Reverse Side
ire Surcharge $. 00 .009 of Permit Valuation (7110th%)
tate Surcharge $_ $.50/$1,000 Valuation
AC Charge $ $1150 per SAC Unit
cense Surcharge $ . c�� $5.00 (State Licensed Residential Contractors)
riveway Escrow $ Att "A" or Alt "B" Above
onion Control $ $450.00 Conservation Plan Review
ark Fee $ Fee Detemvned by Engineering
n Ner Main Charge $ Agreement Necessary ( ] Not Necessary ( ]
TOTAL _;
$2�
ILA-71ONS_
"; O - /
IEW j ] CITY OF FRIDLEY
tDDN j ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ITER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
r
Construction Address:
Legal Description:
Owner Name &A
LIVING AREA:
GARAGE AREA:
DECK AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to'scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
Length Width Hgt/Ground Sq. Ft
E
Construction Typ ed Cost: 7Z -
i
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x
DATE: ® APPLICANT: TeL
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 7 -571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 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 [ ]
STIPULATIONS:
3Uilding
BUILDING
Permit No.: 5 ✓%
[nspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
D&KIc _.
763-502-4977 FAX
EFFECTIVE 1-1-08
°t
)ATE°"
YOUR E-MAIL ADDRESS %�M�yil
ikso coy)')
3ITEADDRESS X71 � k w G �a S� Flit lo 1�� /iJ �
PHIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY OWNER/
NAME: Cle4 rile 0�.
TENANT
ADDRESS:�ry r►V Ili+ CITY /"t
STATEZIP�
PHONE: !{ �°� �'®`�°,
a r
NAME: —
_ ,meg —yam
TDID 1,/40 � JZS-% STATEif" ZIP
CONTRACTOR
ADDRESS: y IJ CITY
SUBMIT A COPY OF
PHONE 66(-784-5 4 p7 FAX
YOUR STATE LICENSE
STATE LICENSE # 2 V6 301 ;L @L EXP DATE
PROPERTY TYPE
INGLE FAMILYMEW CONSTRUCTION SIZE
❑ TWO FAMILYMEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS
❑ BASEMENT FINISH K ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: p—
Of 0 ID 6
SIZE OF IMPROVEMENT
LENGTH WIDTH % HEIGHT
SQ FT
ROOFING
HOUSE ONLY
GARAGE
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
HOUSE &
1. Existing
Floor Plan
GARAGES
❑ ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used.
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
ADDITIONS & PORCHES SUBMIT:
❑ Vinyl
❑Soffit
1. Site Plan/Survey showing the existing structures
❑ Aluminum
❑ Trim
and proposed project
❑ Other
❑ Fascia
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
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:
S G THE 1447 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ 3� OCCUPANCY TYPE
Permit Fee $ See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ .001 times the total job valuation
Surcharge $ 152 .0005 x Permit Valuation Minimum $.50
License Surcharge $ Z 2 $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�a able to: Ci of Fridle Attach Sti ulations
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 U
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 will be in accordance ith th app oved plan '� the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME �� lCe��k DATE
APPROVED BY DATE
I'll M Wo
y.