PRE 2010 DOCSItilities
AS Etie-
AW
SUBJECT
7#ERMIT NO.
City of Fridley
13980
AT THE TOP OF THE TWINS
BUILDING
PE IiNkECEIPT
NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
o---n - CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
4/4/77
JOB ADDRESS 5501 West Danube Road N. E.
1 LEGAL
LOT NO. i(
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
81
2
Innsbruck North 2nd Addn.
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Roger Hertel 3931 Sheridan Avenue
3 CONTRACTOR
MAILADDRESS
ZIP PHONE LICENSE NO.
Kise Construction
Corp. 4141 Reiland Lane, Shoreview, Mn. 55112 484-2090
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
7 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE
8 DESCRIBE WORK
.: cat11t y0
Construct a 38' x 46' Dwelling and a 22' x 24' Garage
solo
nVD
9 CHANGE OF USE FROM D
WIRING,
HGAA' PLUMBIFOR
G AND 5:10
STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side
yards. Provide a verifying survey before capping. Provide truss design before
capping.
SEWER LOCATION: (Approx. 12' Deep in Street) 32' South
of Manhole (Inv. 955.35)
WYE ELEV: 956.82
TOP OF FOOTING: 959.82 Minimum
WATER LOCATION: 4' South of Sewer Service
DRIVEWAY DEPRESSION: N/A Fridley Surmountable Curbing.
.IMPORT ANT—
ft MY W MMW IDES Wt C,IUMAHM IMTHE
FRIDLEY ENGR.
ACCURACY OF UTifJ>RY LCAT AND ELEVATIONS
THIS IS FOR INFORM�APON PURPOSES ONLY AND
DIVISION' DIVISION° REGARDIN CEM�NZ
KEPI-A
DATA
fREMOVAL ANR
PERSONS USING ti SHODUD VERIFY Till IWORIWA
AT DRIVEWAY OPENING!
0" TIE SITA
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE+OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
Woo d FramB
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
1412
33,520 Tota
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
R-1
+528
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.
$42,170
$21.09
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-
$134.08
$375.00
STRUC I N OR THE PERFORMANCE O CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
a ')
&IAT
$33.52
$563.69
OFCONT AC ORI GENT IDA I
N P OPERLY VALIDATED THIS IS YOUR ER 1TTry
BLDG. INSP
Z
DATE
SIGNATURE OF OWNER(IF OWNER BUILDER) (DATE)
Itilities
AS Etie-
AW
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER: BUILDER: ®��j��a4fS / Q 0")X'jV
Address: 9 3 /,p4 Address:
rte,
No.: 57561
Street:
WESZ '74a
-d'— k,�
LOT:
BLOCK:
�!__ ADDITION:,NA§
w -,e 46.
CORNER LOT:
INSIDE
LOT: x SETBACK:
.� SIDEYARDS:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Front: Depth: Vh Height: Z(a
Square Feet: %4// Z__ Cubic Feet: gaZ®
Front: 2 Depth: Height: _
Square Feet: Z Cubic Feet:
Type of Construction: Estimated Cost
To Be Completed: V C ,
=—T /Alt.. A A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
• 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. See reverse side for additional information.
DATE: SIGNATURE:SC
Stipulations:
C.R'? 5
,� 3 ---
f�
EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION
BAER
SITE ADDRESS , .� S"65 / G 4T S T Z6�0�
' CONTR11CIIN 1416,C— DATE PHONE
Oot*mIn 'U" value of each whl segrsnt.
174- ,,/ X "U"
b • x va
C X OU 44
■
s
f. J 2 L-5- X "l I" /� Ij'S a
g ) "70
asl Y
• If Item 03 1sthe same as, or It -
of SK 6006(c!)2 -
• rS_
A9
4 )I, have met the intent
O
40
getenNne working square footage.of each.
1. Tobi expow
wall arm ...... % sq. ft.
x _,1, 7� —b +
2. Total 1"f/coil1n1 area ...... lk3O sq. ft.
x ,M _ ,
Total expos" well area above floor , ■ _ —8
A.
Total
wall vindw arra...........................
• i.
To"T
Nor arra ........... ....................0
,.'.
C.
Tog1
Slidial glass dw area ...................
..—®
d.
Tog1
1hrePlace ra11 area........ ............
---
•.
Total
1A11 frm ng am (average 10%)...' ........
f.
Total
wSt mail area above floor .................
, . i ®i s _
�.
Te%l
raft deist area ............................
. / •tea
°
Total ewam foundation area
L
Total
f IMwdatlo� ri�dor area. .... .............
°grade
J.
Tool
mt founktion arm above ............
a.
Oot*mIn 'U" value of each whl segrsnt.
174- ,,/ X "U"
b • x va
C X OU 44
■
s
f. J 2 L-5- X "l I" /� Ij'S a
g ) "70
asl Y
• If Item 03 1sthe same as, or It -
of SK 6006(c!)2 -
• rS_
A9
4 )I, have met the intent
O
40
s TOtal exposed roof/cei 1 ing' area
�. Total skylight area...
k. Total � � .. _
root ceili framing area (average lOx)...
�r
I. Total net insulated roof/ceiling area. Al
r
Deteruire "U" value for each roof/ceiling segment.
X auto
k. r X 'U" r
r, i
x Nun
5pF
a �..................................Total
If ""I Of /D is the SM as, or less than 02, you have sett the intent of
IK SWO1.
Altiamte Building Envelope Design
To Uttlite !As total ernelope system method, the values established by the
eta ef i"M 03 and 04 shell rot be greater than the sm of ite>As /1 and /I.
•_ 3/9. D .e. (./,0 3D
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Job Address G��-�+l -D&/L) Ljo
Department of Buildings
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, Mn.
KIND OF BUILDING /,5 Q _
USED AS
TO BE COMPLETED ABOUT
PARTIAL RATE SCHEDULE
ESTIMATED COST
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
OLD 1 NEWI BUILDING PERMIT NO.
PERMIT NO.
Number Fixtures
7x
$3.00
$
`
Water
,e
—� x
$2.00
$
Company
',i`'
U ! f e t/
H
q
td
Q
m
b is
pW,
w
Ca
Heater
Catch Basin
x
$5.00
$�
a
c
a
3
g
.d40xW
��
100,000 BTU to 199,000 BTU
u
p�
a"i
Water Softener I
x
04
$
New Ground Run Old Building
x
$5.00
$
ROUGH INSP.
4j
x
$5.00
$
Date
GAS FITTING FEES:
49
va
v
k
Id
cn
y
x
caw
cn
w
Additional Fixtures
x
$1.00
$
Gas Range to 199,000 BTU
x
$10.00
$
APPROVAL FOR PERMIT
ja��
J3�
lst
2nd
3rd
4th
(R) = Future Connection Opening
Connected with Sewer
(*) = New Fixture, Old Opening
Water
Job Address G��-�+l -D&/L) Ljo
Department of Buildings
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, Mn.
KIND OF BUILDING /,5 Q _
USED AS
TO BE COMPLETED ABOUT
PARTIAL RATE SCHEDULE
ESTIMATED COST
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
OLD 1 NEWI BUILDING PERMIT NO.
PERMIT NO.
Number Fixtures
7x
$3.00
$
`
��[ ((C�3
� 0
Future Fixture Opening
—� x
$2.00
$
Company
',i`'
U ! f e t/
New Fixture, Old Opening
x
$2.00
$
Signed By
Catch Basin
x
$5.00
$�
Water Heater - to 99,000 BTU
x
$5.00
$
Tel. No.
��
100,000 BTU to 199,000 BTU
x
$10.00
—�_v
$
Water Softener I
x
$7.00
$
New Ground Run Old Building
x
$5.00
$
ROUGH INSP.
Electric Water Heater
x
$5.00
$
Date
GAS FITTING FEES:
FINAL INSP. m L ®7 7
1st 3 fixtures
x
•$3.00
$
' Date
Additional Fixtures
x
$1.00
$
Gas Range to 199,000 BTU
x
$10.00
$
APPROVAL FOR PERMIT
,
REPAIRS $ ALTERATIONS
First $100.00 $5.00 $
each add. $100.00 or fraction $2.00 $
State Surcharge $ .50
TOTAL FEE $
REINSPECTION FEE
($10.00)
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
.AIR CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
Furnace Shell & Duct Work
Replacement of Furnace
Repairs & Alterations -up to $500.00
Repairs & Alterations each add. $500.00
MECHANICAL WARM AIR:
Furnace Shell & Duct Work to 100,000 BTU
each add. 50,000 BTU
Replacement of Furnace
Repairs & Alterations -up to $500.00
Repairs & Alterations each add. $500.00
STEAM OR HOT WATER SYSTEM:
Boiler & Lines up to 100,000 BTU
each addn. 50,000 BTU
Boiler only up to 100,000 BTU
each addn. 50,000 BTU
OIL BURNER- to 3 gal. per hour
each add. 3 gal. per hour
GAS BURNER- from 100,000 BTU to 199,999 BTU
(over 199,999 BTU see Fee Schedule)
GAS FITTING FEES:
RATE
$12.00
7.00
7.00
4.00
$12.00
4.00
7.00
7.00
4.00
$12.00
4.00
7.00
6.00
$10.00
10.00
$10.00
TOTAL
1st 3 Fixtures x $ 3.00 $ "d 4.
Additional Fixtures x $ 1.00 $
Gas Range to 199,000 BTU x $10.00- $
AIR CONDITIONING $
FAN HEATING SYSTEMSSee Fee schedule $
VENTILATING SYSTEMS $
ALTERATIONS $ REPAIRS $
State Surcharge $ .50
TOTAL FEE s-2- f S-�
ROUGH INSP. REINSPECTION FEE
Date ($10.00)
FINAL INSP. .2 -?
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
Job Address 5501 West Danube
Department of Buildings
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 Cbdes
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.�07 , 19 7
OWNER Kise Const.
KIND OF BUILDING Frame
USED AS Dwq .
TO BE COMPLETED ABOUT
ESTIMATED COST
OLD - NEVXBUILDING PERMIT NO. PERMIT NO. P 90
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam,.Hot Water, Warm AiX No. 1
Trade Name Lennox Size No. G1204-137
Capacity
Total Connected Load
BURNER - Trade Name
Capacity
Sq. Ft. EDR
Sq. Ft. EDR
BTU 137, 000Hp
Kind of Fuel Nat. Gas
Size No.
BTU HP
company Pill City Heating Co.
Signed BY�i-�✓—
Tel. No. 91 559-2500
-.W,k.
"M—A46"O"
m IM WA77
Clan
Exp. wd
Nat "PR
ISL well
Can
Exp. wal
Net exp.
IDL Wall.
Total W& 1 -19: TOW &%
Re*dnd m% (L LDJL of W ims. VA Leader am fr M&
Pmwk4 #% (L E.Q.R.EDA
iax
Q w. - i..._ W A. L a.dss .... 1 - ' 11 K mimd m IL LMJ
CITY OF FRIDLEY INSPECTION DIViSION
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)
197o of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate TOTAL
$ 3t).00 $
$ 10.00 $
$ 10.00 $
$ 10.00 $-
$25.00
$25.00 $A5��
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 withcut
written permission from adjoining property owner.
$ .50
Effective On January 1, 2001
JOB ADDRESS5561
OWNER
BUILDING USED ASL�C jL _
ESTIMATED COST 4_ PERMIT NO.�
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units_ Circle One (Steam) (Hot Water) wim Air
Trade Named ! Size No.
BTU -15, ®moo HP EDR
Fuel 'c - Cn cAS _ Total Connected Load
Burner Trade Name Size No._
BTU HP ED
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 �- Q -o )'
ROYALTON HEATING & CO
HEATING CO 4120 - 85t6 AVENUE NORTH
9
MN 55443
Signed 763_424-8333TEL # _
_ Final Date
Approved By a X Rough -In Date
BACK SIDE MUS BE FILLED IN ON VENT SIZE, VENT CONNECTORS
AND COMBUSTION AIR VERIFICATION
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 speci;ications. Yes ( ray
When installing 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 K) No( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type_
Appliance #2 Type _
Appliance #3 Type _
Total Appliances
Common Vent Type
— BTU Input
_ BTU Input
_ BTU Input
Total Btu Input
Fan Assisted or Nat
Fan Assisted or Nat
Fan Assisted or Nat
Vent Height Diameter inches
Appliance
#1
Vent Connector Height
ft
Length ft Diameter
in Type
Appliance
#2
Vent Connector Height _,—ft
�ft
Length _�.ft Diameter
in Type
Appliance
#3
Vent Connector Height
Length ft Diameter
in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By:
OW
IOU •yoa}aAum@UOtle/toa :IIbVV-3 • 1.598-tZb (ZL9) :XV:J • EEE8-tZt, (ZL9) :3NOHd
£tIti55 ` -LOS3NNIVI '>IHVd NAINOOHE3 • HiHON 3nN3AV H198 OZIt,
RM -110 MOM 1
`1
SUBJECT
P --Nd'. ."r.
City of Fridley
33558
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
` COMMUNITY DEVELOPMENT DIV.
__�___
r v PROTECTIVE INSPECTION SEC.
1 . �
NUMBER
REV
DATE
PAGE OF
A ROVED BY
1 Z 1 CITY HALL FRIDLEY 55432
,.' 763-571-3450
910415
5/27/03
10B ADDRESS 5501 West Danube Road NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
8
2
Innsbruck North 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Corey & Pat Lomen 5501 West Danube Rd NE 763-571-1497
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Midwest Roofing & Siding 313 Jefferson Hwy, Champlin, MN 55215 763-427-9696
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
20010277
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION Q REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage 30 S Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
4
&.
n
Mailed
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
1STALLS 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
$3,473
$1.74
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$97.25
Fire SC $3.47
PLAN CHECK FEE
TOTAL FEE
Lic nse SC $5.00
$107.46
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE,
HEN PROPERLY VALIDATED THIS IS YOUR P�/-��@-yRMIT
S,GNATURE OF OWNER SIF OWNER BUILDERI IDATEI
13LOG INSv OAIE
`1
Mam 27 03 09:45a Theresa @ Midwest 763-427-9001 P.1
NEW () CITY OF FRIDLEY Effective 1/1/2003
ADDN () 6431 University Ave NE, Fridley. MN 55432 (763) 572-3604 Bldg insp
ALTS {) SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (yea) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: �J ��•�
Legal Description:
Owner Narne & Address: Co, -e-,
Tel.# i(o3 S%/ 1 407
Contractor: Midwest Ido $iag & Siding MN LICENSE d Pao / ua T�
Address: 313 Jefferson I •y.
�{Tr,MAI 5: ' " Tel. a � (S+ 3 ya7
vhe
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to sc 1e.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. FL
GARAGE AREA: Length Width Height Sq. Ft.
DECKAREA: Length —r Width7� Hgt/Greund Sq. Ft. •
OTHER:
�— v J4/
Construction Type: ► i s er e ro�� Estimated Costs,
Driveway Curb Cut Width Needed: Ft. t 6 Ft = Ft x $ = g
DAT E•:! �.3�L APPLICANT: Co•�.�r'a,r —rte a
Call (763) 572-3604 for Permit Fees i7 mailing in application. Fax to 763-571-1287 if using credit card and we will r
call you for Card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Parc Fee
Sewer Main Charge
CITY USE ONLY -
TOTAL $
Fee Schedule on Reverse Side
.001 of Permit Valuation (III MON
$.50/$1,000 Valuation
$1275 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt 'W or Alt 'B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary I I Not Necessary I I