PRE 2010 DOCSBUILDING PERMIT
'
Village of Fridley, Minn. N° 2221
Date � � .... .. .................... .
Owner . .f:r ....�- ...... Builder ...........................................
go-S
Address�t .� :...'S .............. Address .........................................
LOCATION OF BUILDING
No. /kV ......... Street .....".4i' ................ Part of Lot .......................
Lot .............. Block ................ Addition or Sub -Division
urt... .. ; .. .
Corner Lot ...... .... Inside Lot ............ Setback Sideyard �';� ............
To be Used as:
Type of
DESCRIPTION OF BUILDING
Front .. •,;%i... Depth Al ... Height .r! Sq. Ft......... Cu. Ft, ........
Front ........ Depth ........ Height ......... Sq. Ft......... gCu. Ft........ .
n ,,r Est. Cost ':..., . , , , , , , , To be Completed
In consideratioof the issuance to me of a permit to construct the building described above, I agree to do
the proposed work 10 accordance with the description above set forth and in compliance with all provisions of
ordinances of the age of Fridley,
�In con Weration f the payment of a fee of $.. . , permit is hereb granted to ....
A. .. ... to construct the building or addition as described above. This permit $ wanted upon
7expresg, diti • that the person to whom it is granted and his agents, employees and workmen, in all work
doar d and 4on said building, or any part thereof, shall conform in all respects to the, ordinances of
Fridley, Minnesota r garding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village IlWlts� d this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
F
_-- ; ", • . .. �:� Building Inspector
Loll
NOTICE:
This permit d'es not cover the construction, installation or alteration fog wiring, plumbing, gas heating,
sewer or water. sure to see the Building Inspector for separate permits. for these Items.
City of Fridley, Minn. N° 8563
13 //2.s
r
BUILDING PERMIT
Date: OCTOBER 26, 1965
Owners RUSSELL A. FREEBERG Builder JOSEPH E. MEN
Address _ 160 - 53rd Avenue N. E. Adm 5239 - 4th St. N. E.
Fridley 21, Minnesota
LOCATION OF BUILDING
No. 160 Street 53rd Avenue N. E. Part of Lot
Lot 6 Block 1 Addition or Sub -Division Carlson's Summit Manor. North Addn.
Corner Lot _ Inside Lot $ Setback —_ Sideyard
Sewer Elevation _ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
KTTCM ADDTT.101hmt 10 Depth _ 10 Height ._._-_. Sq. Ft. 100 Cu. Ft. ROD
Front Depth _ _ Height . _ Sq. Ft. - Cu. n
Type of Construction Frame Est. Cost _$12400.00 __ To be Completed
In consideration of the issuance to me of a permit to et the buil des I to do
the proposed work in accordance with the description abo se Porth and ro om wl ons of
ordinances of the city of Fridley. �� _
In consideration of the payment of a fee of I't 9.00 _, permit is hereby granted to JOSEPH E.
MEN 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 thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding it may revokedat alteration, uponviolationot any of t pand rovisions s o�eaid
whom city ]units and this
ALLEN G. JENSEN
NOTIM
M psrmh does not emu the eoeatruedw, lm tdlaflon for wiriee, phmbine, on heatiao, sm wr or waftr. Be am to me
the Bundles hopmer for apmft peemMa for thea Meme.
a
OWNER'S
APPLICATION FOR BUILDING PERMIT
OF FRIDLEY, MINNES
ADDRESS
LOCATION OF BUILDING
Street re� :k
Part of Lot
...LOT R ADDITION OR SUBDIVISION
Corner Lot Inside
..SEWER ELEVATION FOUNDATION ELEVATI'
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To b used �/� x _
• /� / (d
Ont Dept Height
Sq.
Sq. Ft. /� Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft./ /
Type of Constructio Estimated Cost ZZ111d
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 Buildings, and hereby declares that all the facts
and representations stated in this appl a ion are true and cbvwect.
DATF, SIGNATURE �1✓
(Schedule of Fee Costs can be found o� Che Re�/erse Side).
J
City of Fridley, Minn.
BUILDING PERMIT
Date: June 5 1970
Owner: Mussell Freeberg Builder
Address 160 N.E. 53rd Avenue Address
Same
Same
!> y
N. 1069
LOCATION OF BUILDING
No. 160 Street .__. 53rd Avenue N.E. ____ Part of Lot
Lot _ 6 _ Block 1 Addition or Sub -Division -Carlson's Summit Manor North Addn.
Corner Lot —_ Inside Lot —X _.._.._ _ ..__ Setback __3 51 --- Sideyard
Sewer Elevation _ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Garage Front 22' Depth 26 Height 10' Sq. Ft. 721 Ct. Ft. —5720
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction F ram Est. Cost To be Completed 6 Months.
Provide Hardsurfaced Driveway
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. _ - A
In consideration of the payment of a fee of $ 11.00 , permit is hereby granted to Russell Freeberg
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
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
P
E �
CLARENCE BELISLE
NOTICE:
TM@ permb don not corer the coniruction, installation for whine, plumbing, gn heating, aver or water. Be aro to an
the Building hupecter for separate para is for these items.
0 40
s
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S
NAME: z'
0SS°Z:'1. Z?j_-48,&9G
BUILDER:
0 t AIeR
ADDRESS :
/0/®
/IIS ,.s /4 YE •
ADDRESS:—
SA M E
NO:.- ltl�e STREET: '3-.3 '4 lI , /Y Z- .
/ c,gRL5o,vs 5'oi+rMiT,w.4 /Ve,
LOT: BLOCK: ADDITION: NoR TN fI P.P17"/o Al
CORNER LOT: INSIDE LOT: I,"" SETBACK: --?-f` SIDEYARD•
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING T
To Be Used As:
G' 4,f Front • 1217— Depth: 024 Height • .16
Square Feet: ✓�% Cubic Feet: -5-7.2 -6
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction:Estimated Cost:
To Be Completed: 6 /00,5,
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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.
DATE: g, - -I;--- 7d ' SIGNATURE : a,
(See Reverse Side For Additional Information.)
0
SUBJECT
City of Fridley
2
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV
1 V
r PROTECTIVE INSPECTION SEC
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
,.j 612-571-3450
910-F15
5/15/97
JOB ADDRESS 160 53 Avenue NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
1
Carlson's Summit Manor North Addn SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Richard Hapka 160 53 Avenue NE
586-0765
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Same
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 Ej NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 10' x 16' Shed
9 CHANGE OF USE FROM TO
STIPULATIONS
Shed must comply with the City Zoning 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
$750
$.50
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-
$29.25
Fi SC $.75
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
T ALFEE
$30.50
OF CCCON/TRRACTOR OR AUT ORIZED AGENT IDATEI
EN
VALID T THIS IS YOUR PERMIT
"y/SIGNATURE
�7
�.
B� IN P
V--,/i
SATE
SIGNATURE OF OWNER IIF OWM'ER BUILDERI IDATEI
NEW D< Effective 1 / 1 /97
ADDN L 1 CITY OF FRIDLEY
ALTER [ ] SINGLE FAMII,Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstmctionAddress: Z (--6 S 3"
Legal Description:
Owner Name & Address: C ��� e ,,�,.; Tel. # J d (
Contractor:
Address:
MN LICENSE #
VII
Tel. # 5-q 5'. +N l O
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EVIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width 1,0 Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type:_ �/lfo �, c� Estimated Cost: $ rG o
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: 5�' j 3 ` 7 APPLICANT: �� 1 f,� Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$950 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 [ ]
SUBJECT
P
City ®f Fridley
28754
AT THE TOP OF THE TWINS
BUILDING
PERMIT
Ir
RECEIPT NO.
y_ _ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC
1345
r I PROTECTIVE
1 ; ,
NUMBER
REV
DATE
PAGE OF
APPROVED By
I / 1 CITY HALL FRIDLEY 55432
It""JiiI" %.1
612-571-3450
910415
112/15/ 98
JOB ADDRESS 160 53rd Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1 6
1
C.S.M. North Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Richard Hapka
586-0765
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Up Top Construction 2737 111th Ave492-9799
7719
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 IM REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
X Reroof house and garage
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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
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
$2056
$1.03
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CH GE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$74.75
Fir S $2.06
PLAN CHECK FS
TOTFE4Li
50
SIGNATURE OF CON'RACTOR OR AUTHORIZED AGENT ,DATES
EN ROP
AL OAT T SIS YOUR PERMIT
BLD -NSo
r
UArf
S-GN4TURE OfOW NER ii%OWNER BU0.DERi �DATEI
NEW- `[ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Owner Name & Address:
Contractor:
Address:
7W
Tel. # 674 -- cl;.e,, -5-
MN
MN LICENSE # 7 71,0?
Tel. # $Q,,? —,f 7f,5 -
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: Length Width Hgt/Ground Sq. Ft.
OTHER:
(j G- C;2'7 0 0
Construction Type: '-e,, - /� � F Estimated Cost: $ 3T5 90
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Et-� Ft x $ = $ 17®,x(®
DATE: APPLICANT:
Permit Fee
$ ?4/ l
Fire Surcharge
$ a?. 0 G
State Surcharge
$ ) 6 3
SAC Charge
$
License Surcharge
$ 5( 0 0
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $ g
STIPULATIONS:
Fee Schedule on Reverse Side
Tel. # —,F 7F,6-
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 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 [ ]
CITY OF FRIDLEY INSPECTION DIViSION
Effective On January 1, 2002
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
JOB ADDRESS 160
RATE SCHEDULE
OWNER MdKC4 �� l
Residential
Rate
TOTAL
Furnace Shell and Duct Work, Burner -BUILDING
USED AS
Also Replacement Furnace
$ 30.00
$ ��-�
r
(Side Vent - Fill Out Back)
ESTIMATED COST 3,2�a PERMIT N0. / /�
Gas Piping (Needed with new furnace,
$ 10.00
$
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNER
Gas Range
$ 10.00
$
No. of Heating Units Circle One (Steam) (Hot Water) Warm Air
Gas Dryer
$ 10.00
$
Trade Name Caffd�— Size No.
BTU garOuJ HP EDR
*Air Conditioning - All Sizes
$ 25.00
$ ��--�
Fuel Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK)
Burner Trade Name Size No.
1% of Value of Appliance or Work
$
BTU HP EDR
Commercial/Industrial
1.25% of Value of Appliance or Work $ 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
State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and
TOTAL FEE S�
-—• Sb representations stated in this application are true and correct.
$ � %
j0,DATE �4 /UZ
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION /�� S� HEATING CO A
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE Signed TEL #
FAX # $o s
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without Approved By/'C Rough -In Date Final Date
written permission from adjoining property owner.
l-7
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
COMMON VFNT. VENT CONN .TOR AND.OMRIISTION AIR VFRIFI .ATION
When ro In acing 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 0j No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes (�f No ( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes M No( )
The existing comhustann air is sized and installed to meet the current codes
and manufacturers specifications. Yes Y) No( )
When required to install a now rnmbustinn air.itwill be sized and installed
to meet the current codes and manufacturer's specifications. Yes No( )
When installinrj a new v _n ing cyc em, 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 Sipe1Cnmmnn Vent and Vent Conn _rtnr Informa" inn
Appliance #1 Type w- BTU Input 60.000 Fan Assisted or Nat 111A4—
Appliance #2 Type ,., A,.kr 14A..kur- BTU Input-)o,vou Fan Assisted or Nat ivy
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances_ Total Btu Input
Common Vent Type
Vent Height /Z` Diameter 5S 1 inches
Appliance #1 Vent Connector Height 1 Y ft Length f1* ft Diameter 4� in Type c.
Appliance #2 Vent Connector Height f _ ,5ft Length r. ft Diameter�in Type G
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
HEATING CO: �✓�, �� r4� /
Signed By: Date:
Building
$
BUILDING
Permit No.: %
inspections
$
RESIDENTIAL APPLICATION
Received B : 7
763-572-3604
$
CITY OF FRIDLEY
Dao' 9. M— W*
c�
DATE/ a q (07 YOUR E-MAIL ADDRESS 4 o dl 5 LD f- I d r l-1-, U5,. `O' Off) J
SITE ADDRESS
7 r
I HIS APPLICANT IS:
❑ OWNER 01GONTRACTOR
PROPERTY OWNER/
NAME: Mike
TENANT
/� /
ADDRESS: (L Li 13 "1 /hV . /V E CITY Trp it It L / STATEMkIP157 b
$
PHONE: —I -6 3 1 ; 71-16 b 5L.
CONTRACTOR
NAME:_ The Home Depot A.H.S. Inc.
SUBMIT A COPY OF
sTATE LIc 3200 Cobb Galleria Pkwy. q 5A % 3 4 S - G b -L(7
YOUR STATE LICENSE
ADDRESS: Atlanta, GA 30339 CITY STATE ZIP
WITH APPLICATION
PHONE 763-542-8826
#20268257
PROPERTY TYPEA
ark Fee
o TwoLicense _nes
PERMIT TYPE
Er ADDITION ❑ GARAGE/SHED WIDOWS
ewer Main Charge
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
Iotal Due
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MA NTENANCE/REPAIR [ REMODELING
DESCRIBE WORK BEING DONE: LJ► j Q X / / Lp f
SIZE OF IMPROVEMENT LENG WIDTH HEI Sq. Ft
tOOFING
❑ HOUSE ONLY
DUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
;ARAGES
❑ ATTACHED GARAGE
1. Existing Floor Plan
'ROPOSED SIZE:
❑ DETACHED GARAGE
2. Proposed floor plan
3. List of structural members to be used
'ROPOSED HEIGHT:
>IDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
3 Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
3 Aluminum
❑ Trim
1. Site Plan/Survey showing the existing structures
7 Other
❑ Fascia
and proposed project
ifINDOWS
2. Two sets of construction plans
EXISTING OPENINGS BY`es ❑No LOCATION OF WINDOWS k� wn �Ll�lU d
3. Energy Calculations
)R FOR NEW OPENINGS -DESCRIBE SIZE OF bad
)PEKING CHANGES &
1
YPE OF WINDOW TO BE INSTALLED
NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION Cl
(USING T1 1997 U.B.0 FEE 13 SCHEDULE)CU TYPE
Iermit Fee
$
i3 .
See Back Page for Fee Schedule
'Jan Review
$
65% of Building Permit Fee
,urcharge
$
1. 4 to
(.0005) times the total job valuation — Minimum $.50
'ire Surcharge
$
,i .q l
.001 x Permit Valuation (1/10%)
.Jcense Surcharge
$
O V
$5.00 (State Licensed Residential Contractors)
AC Charge
$
$1450 per SAC Unit (Plans to MWCC for determination)
.urb Cut Escrow
$
ft + 6 ft = ft x $20 = $
iosion Control
$
$450 Conservation Plan Review
ark Fee
$
Fee Determined by Engineering
ewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Iotal Due
$
9 a . Ga
Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
enformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
ermit but only an application for a permit d ork is not to start without a permit; that the work will be in accordance with the approved
tan in the case of all work which requires re i and. approval of plans. / C' /()7:GNATURE OF APPLICANT �.� PRINT NAME : "r MSr henk DATE�-