PRE 2010 DOCSCity of Fridley, Minn..
BUILDING PERMIT
Date; July 1, 1970
Owner: Lavern Miller Builder Clemron, Incorporated
Address _._ 1330 -52nd . Amennue N - E- Address 4411 Central v -n , N F
LOCATION OF BUILDING
N 1073-�
No. 1330 Street 52nd Avenue N.E. Part of Lot
Lot 4 _ Block 2 Addition or Sub -Division Marion ills -2nd Addition
Corner Lot Inside Lot X Setback 35' Sideyard 191
AERKIElevation ___ 946-99 Min Approx.- 9.49 9.9
Wye TOP OF FOOTING
DESCRIPTION OF BUILDING
To be Used as:
House Front _26' Depth 39' Height 20' Sq. Ft. 1068' Cu. Ft. 21,368'
Garage Front 271 Depth 22' Height 10' Sq. Ft. 516CtL ft - 5160,
Type of Construction Frame Est. Cost —.__$35,000-00_ To be Completed Sega: 10, 1970
Verify Basement Location By Survey.
WATER LOCATION: 10' West of Sewer Service.
SEWER LOCATION: 36.6' West of Manhole
In consideration of the issuance to me of a permit to construct the building described abov I agree to do
the proposed work in accordance with the description above seL/Aand ce ons of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 48.00 , permit is hereby granted to Clemron, Inc.
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom fit piss gtranted and his agents, employees and workmen, in all work
done Fridley Minnesota regarding around and naobcaattion,gconstruuction, alteratiion, maintenancshall conforme repair aall mend moving to the 000f�buces of
ildings
within the city limits athis permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
zBuilding Inspector
HANK MUHICH
NOTICE:
'This permh does not cover the condrueHon, Installation for wiring, plumbing, gas hearing, ewer or water. Be sure to see
the Building Inspector for separate permbs for these hens.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNES 'S
ADDRESS 3 ;z / ADDRESS Wall Central Ave. N.E.
Mpls.
LOCATION OF BUILDING /^
N0. 13 10 STREET �_V ,e _ �/—
LOT 1�_ BLOCK 2 ADDITION OR SUBDIPISION Marion Hills -2nd Addition
COWN''ER LOT INSIDE LOT g SETBACK 351 . SIDEYARD 191
SEWER ELEVATION
TOP OF FOOTING
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 As: Resident
Aorise Front 261 Depth 391 Height 44-
E j C, ,
Square feettm Fig, Cubic Feet
GaraiFront 271 Depth 221 Height
Square feet -9A: Cubic Feet
Type of Construction Frame Estimated Cost 935000-00
To Be Completed September 30th
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 i�.,;resertations stated in
this application are true and correct. Clem
DATE A-25-70
(Schedule of Fee Costs can be found on the
by
Zemdfior7n,r7(4a&tr6an,
r 875 ;flj Alt.
ta7d &ewyuy M/inAqlahim
St,r/3k3frrry NGINEERING, INC. "am>o
civil & AfwipMl
i
E; --- E"rs Surveyors ---
certificate of sumvey fo: Nt-L 'SHAN
N0f�T
0
ti
t
b
90.0
LOT 4-, BLOCK ?-,MARIAN HILLS 2"!OADDI ION
�� •"" be#1.;tF..slv:. c'n v G►'YD475t.J '1100 V1"9 fay. P{t7Jst
+._
1 he-e6y c -!44y fVid #r* is a bw and awred m r i tct� 4 a swwy fe beeae&4aw ql'* 46eo of wvAd Cod, obi
t rhli &4hiw ear 4v� , &Yew. midall nsi* al wdpvaali ,gra . %►'>�n W 07ANd /ted As Byrd lyIW thid
A.o &At.SUBURBAN EKGINEERIN0 INC.
•+ 'I
E
1 /Z, \
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17
1 /Z, \
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Original •
PERMIT for Power P ants and Heating. Cool-
ing, Ventilation. Refrigeration and Air
Conditioning Systems and Devices
DESCRIPTION OF WORK
No. of ` Heating Plants W atenr a-4to be ' tolled ed—repaired
Make - CLQA1 n AAL J , Size L0- /a S ;
Oil fared , Coal fired , Gas fired- ; Gas Authorization No.
Remarks AA,ny�1J�i ���� �� UJ � - (20-1d W j-4 AU -
Approved
Final Inspection Date , 19_
Inspector
S-,)- e� 7
Permit ]vv 4'7'76
Fee $
Office of the Inspector of Buildings
City of Fridley
City of Fridley, Minn. , 192d
Owner -
Location -1JJQ - �5-AAS aZe�=Q2
Kind of Building�2,�rYL.�>
How Occupied
Work to be Commenced—, 19
To be Completed ,19%O
Estimated Cost, $ <p `%S" Q
Old ew, Building Permit No.
Permission is hereby granted to V to install—erect—use the material and devices described in the
above statement. This permit is granted upon the express condition that the person.0 whom it is granted, and his agents, employees and workmen, in all the work
done and materials used under this permit, and in the operation of the devices herein Mentioned shall conform in all respects to the ordinances of the City of Fridley
relating to or governing the work to be done and the operation of the devices herein named, and to the specifica ' set forth in the approved application for this
permit on file in the office of the Inspector of Buildings. / . '
Inspector of Buildings
az 2M11.67V
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URI
BATH
TUBS
I--, (BASINS
(SINKS
\ IWASH "'I
TRAYS �I
DRINK p•
A
FOUNT. rQ.
O x
(SHOWERS a p
O
FLOOR i7
DRAINS
(CATCH 4'
BASINS Ip
to
RAINW.
LDRS.
MISC.
FIX.
GAS
APPL.
GAS
RANGE
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m
In �
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. cy
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1
51 4 . In
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I WATER
URI
BATH
TUBS
I--, (BASINS
(SINKS
\ IWASH "'I
TRAYS �I
DRINK p•
A
FOUNT. rQ.
O x
(SHOWERS a p
O
FLOOR i7
DRAINS
(CATCH 4'
BASINS Ip
to
RAINW.
LDRS.
MISC.
FIX.
GAS
APPL.
GAS
RANGE
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m
In �
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1
51 4 . In
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`iffy of Wadley
Applic flm for and Gas Pwmit
Dept. of Bldgs. Phone 560-3450 - • - -
DESCRIPTION OF WORKf 33O
Number. Kind and Location of Fixtures C
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 ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application true and correct
A Fridley, Mi
dleynn / / .D , .2-0
Kind of Building
• future Connection Openings I wanecsea wuSewer a
* Now Fixture. Old Openings Cesspool n Used as
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
� bD
Number Fixtures ................ ® x $2.00 $
Future Fixture Opening ........... x $1.50 $ _
New Fixture Old Opening .......... x $1.50 $
Catch Basin ....................
x $3.26
all
l
0
M
3, ° n
Water Heater ;Up to 99.000 BTUI....
x$3.00
$
MMMMIN
New Ground Run Old Bldg.........
x $3.25
$
Eleatric Water heater ..............
: $2.00
$
GAS FITTING FEES:
NO. RATE
TOTAL
21 -
1st3Fixtures •••••..•••••.••
a 32.00
s
Additional
Additional Fixtures ..................
x $ .75
$
Gas Range to 199.000 BTU-
x $6.00
$
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 ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application true and correct
A Fridley, Mi
dleynn / / .D , .2-0
Kind of Building
• future Connection Openings I wanecsea wuSewer a
* Now Fixture. Old Openings Cesspool n Used as
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
� bD
Number Fixtures ................ ® x $2.00 $
Future Fixture Opening ........... x $1.50 $ _
New Fixture Old Opening .......... x $1.50 $
Catch Basin ....................
x $3.26
$
l
3, ° n
Water Heater ;Up to 99.000 BTUI....
x$3.00
$
New Ground Run Old Bldg.........
x $3.25
$
Eleatric Water heater ..............
: $2.00
$
GAS FITTING FEES:
NO. RATE
TOTAL
21 -
1st3Fixtures •••••..•••••.••
a 32.00
s
Additional
Additional Fixtures ..................
x $ .75
$
Gas Range to 199.000 BTU-
x $6.00
$
REPAIRS A ALTERATIONS—Refer to Code
Description ..............................................
TOTAL FFA
2 as
To be cc
Estimated
� Cost, $ _
Old—dVev�. Building Permit No. Permit No. / b
oy
Signed.
By -
Business Phune No
ROUGH
FINAL SZ" — ► ?
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective On Jan 1, 2000
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"
NO. RATE TOTAL JOB ADDRESS
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
$ 7.00
The undersigned hereby makes application for a permit for the work herein
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
$ 5.00
and rulings of the Building Division, and hereby declares that all the facts
$ 7.00
and representations stated in this application are true and correct.
$ 7.00
$ 7.00
$ 7.00
$10.00
Owner
$ 7.00
$10.00
Building Used As�_��c
$10.00
$10.00
Estimated Cost PERMIT NO.
Type $15.00 PLUMBING
Reinspection Fee $47.00/Hr SIGNED BY
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
Approved By Rough -In Date Final Date — ®®
State Surcharge $ .50 L /GAS PEI,11kjK1
TOTAL FEE $--f= 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
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 manufacturers 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 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( )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 Length ft Diameter in Type .
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :
CITY OF FRIDLEY INSPECTION DIViSION
0-61
Effective On January 1, 2001
6431 University Ave NE
q-;
Fridley, MN 55432 APPLICATION
FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
763-572-3604
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS
RATE SCHEDULE
�j�%
OWNER j✓//
Residential
Rate TOTAL
Furnace Shell and Duct Work, Burner -
BUILDING USED AS
Also Replacement Furnace
$ 30.00 $
(Side Vent - Fill Out Back)
ESTIMATED COST PERMIT NO.
Gas Piping (Needed with new furnace,
$ 10.00 $
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNER
Gas Range %%��
$ 10.00 $
S f�
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Gas Dryer 9
$ 10.00 $
Trade Name Size No.
BTU HP EDR
*Air Conditioning - All Sizes
$ 25.00 $
Fuel Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
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
$ .50
$ �S-- S?b
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
HEATING CO
Signed / TEL #
*Air Conditioners can not be placed in a side yard without Approved By v Rough -In Date Final Dafe`
written permission from adjoining property owner. 1
BACK SIDE MUST.SE 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 existina 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 ventina__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 I 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
Building
Inspections C
7.63-572-3604
DATE I—
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
q- 0c -
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YO E-MAIL ADDRESS
❑ OWNER 11CONTRACTOR ,nom
NAME 1 \� V" ` , 1 , -e_ r STATEYi1PVLIP 5 I
ADDRESS: 133 O r v N- CITY E
PHONE: -110 3 ' - 3°2
COMPANY NAME: CENTERPOiNT ENERGY
CONTACT PERSON: JOANN ZI14M
STATE LICENSE # EXP DATE
ADDRESS: 13562 CENTRAL AVE NE CITY ANOKA STATE 1�1NZIP 55304
PHONE 763-757-6202 FAX 763-757-6701
Permit No.: �,�O(O "0 4 `L
Received By:
it
Date Rec'd: I , �k` 00 '
PERMIT TYPE I)C-SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: ❑ NEW PLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK �,� a `e \ ` C J' t
�
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 = $15.00.
Labor cost between $300 to $500 = cost of labor x .05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)r
r `e✓ MODEL: � q k - bay SIZEMTU R 4O N
Equipment Installed
MFG SIZE/BTU
MFG: MODEL:
$25.00
SIZE/BTU
MFG; MODEL: _GAS RANGE/OVEN $10.00
_FIREPLACE (GAS) $15.00 NEW GAS GRILL $10.00
_LA/C
AIR TO AIR EXCHANGEER $15
_FIREPLACE (WOOD) $35.00
UNIT HTR $10.00
BOILER $35.00
LINER $10.00
_FURNACE $35.00 _GAS
_GAS DRYER $10.00 POOL HEATER $35.00
VENTILATOR $15.00
_CHIMNEY
DUCT WORK $10.00
GAS PIPING $10.00
��%.+. ..,pM�„'.rr.7i;�'�`+1r! ..._..`F�'A�.l\'y,Yi�'. �Jyd.r(av7iW,vw,v_....,. .: c.•..;,;r_-r...a, :.:,,....... ._-,......,._... _..._.__..
Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ Number of fixtures @ $25.00 x $25.00 = $ .ZS •�
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Total = $
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 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 requiresreviewand approval of plans. /
SIGNATURE OF APPLIC..PRINT NAME ROGER HOF IN DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
741_1q7')_1604
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS XEXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/TGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. TMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
.a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make up air calculations
Building
$
BUILDING
Permit No.: '1,0o 4� //0/
Inspections
I
65% of Building Permit Fee
RESIDENTIAL APPLICATION
$
Received By:
763-572-3604
$
CITY OF FRIDLEY
License Surcharge
Date d 4 9
763-502-49,777 FAX
SAC Charge
Curb Cut Escrow
$
$
$2000 per SAC Unit (Plans to MWCC for determination)
�ft +)Kft ft x $22 = $=� �Ivi�y��i/"f�)
Erosion Control
$
EFFECTIVE 1-1-09
Park Fee
$
Fee Determined by Engineering
/
��
DATE /
YOUR E-M6IL ADDRESS ✓
i
SITE ADDRESS
THIS APPLICANT IS:
OWNER ❑CONTRACTOR
PROPERTY OWNER/
NAME:
TENANT
ADDRESS _ ITY
STA ZIP--='yG
PHONE: _
CONTRACTOR
NAME:
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # EXP DATE
AND CERTIFICATE OF
ADDRESS: CITY
STATE ZIP
INSURANCE
PHONE FAX
PROPERTY TYPE
INGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
❑ HOUSE & GARAGE
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:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
I .
Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
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:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION S OCCUPANCY TYPE 'A
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
I
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
Curb Cut Escrow
$
$
$2000 per SAC Unit (Plans to MWCC for determination)
�ft +)Kft ft x $22 = $=� �Ivi�y��i/"f�)
Erosion Control
$
$450 Conservation Plan Review /
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
Make checks navable to: Citv of Fridlev Attach Stipulations
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 permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of all requ' s r proval of plans
SIGNATURE OF APPLICAN `// PRINT NAME�'s"/��� ATE