PRE 2010 DOCSBUILDING. PERMIT
Village of Fridley, Minn. No
Date...... ....................
Owner ...... ...... Builder
Address . J.........��.: .dv+'. ....
' .. Address
i
2975 /
LOCATION OF BUILDING
No. .O ..... Street ... V . �. . Gf!�............. Part of Lot .......................
Lot ..... ✓�.......... Block .... ...... Ad on or Sub -Division ..
. 4!. ...
Corner Lot ............ Inside Lot ............ Setback `s!...... �Sideyard
DESCRIPTION OF BUILDING
To be Used as: Cr
. P OIUA4 � Front _91. Depth 4 f... Height ... Sq. Ft. YP Cu. Ft.
.................... Front ........ Depth ........ Height ......... _ Sq. Ft......... Cu. Ft. ......
O® •� /�
Type of Construction .......... Est Cost .� � To be Comp leted ✓LT
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 compliancewith all provisions of
ordinances of the village of Fridley.
In consideration of the payment of a fee of $4K t is hereby granted to ..... .
.......................
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
din Inspec
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing,gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
W
IN0Wft6XA' e'"" C. E. COULTER I��, I PLATTING
BUSINESS �I FARM SURVEYS
CITY LOTS LAND SURVEYOR LAKESHORE
TOPOGRAPHIC MAPPING REGISTERED UNDER LAWS OF STATE OF MINNESOTA JUDICIAL
LICENSED BY ORDINANCE OF CITY OF MINNEAPOLIS
3300 LYNDALE AVE. SO. MINNEAPOLIS 8, MINN.
TAYLOR 4.0370 �•
�urcr$�c9.t'�e iirrti#ir� !
67
m y
C
I 1
I �
I hereby certify that the above is a true and correct plat of e survey of:
Lot Seven (7), Llock Five (5), RICE CREW PLA,',A SUM ADDIL 01,', Anoka County, V.innesote.
As surveyed by use t.Iis 1st day of !gay 1956 A, D.
Signed ,$ y�r
Ninne:3ota t, Registration IUC. 2584
City of Fridley, Minn.
BUILDING PERMIT N° 6 0 9 7
Date:
Owner: Builder eZ,,. L J
Address Address
TION jOF BUILDING
No. Street _ r Cl Part.
Lot _ ___0, W—Y'—V�
__ _Block Addition or Sub -Di
Corner Lot _ Inside Lot I tback Sideyard —_
Sewer Elevation __._ FowAtion Elevation
DESCRIPTION OF BUILDING
.�
0� . Front Depth Height Sq. Ft ! +r:► Cu. Ft
Front: Depth �. Height Sq. Ft. Cu. Ft
Type of Construction � Fast. Cc§i_ """ To be Completed
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
JF—
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 reg location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any tide upon violatfo`i� of any of the provisions of said
ordinances. -"'� .4'A . /
NOTICE:
Thio permb does net eowr the eonatruetlon, hm taWon for wking, phrmbk& pe haNeg, aw.r or crater. Be sen to we
the Building Wpocter for aparata pormka for thea Noma.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
AddressOwner's Name Builderl,/_.e_��.,
/ Address_ I
LOCATION OF BUILDING
No. Street 9 ate •_Part of Lot
Lot %' Block .g— .Addition or Subdivision
Corner Lot Inside Lot 4-:- 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.
To be us ed- as
DESCRIPTION OF BUILDING
Front / (, Depth Height j9
Sq. Ft. !� Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type ,of Construction -Estimated Cost %�v
_ l - _._
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 application
are true and .correct
DATE SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
- . ._ 1 0
0
1
. . r 0
1+
01
SUBJECT
City of Fridley
.�
AT THE TOP OF THE TWINS
BUILDING PERMIT
Ir
RECEIPT NO.
� ; COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
I �!
r I
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
4/25/96
JOB ADDRESS 240 67 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR,
7
5
1 Rice Creek
Plaza South SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Terry/Barb Clint 240 67 Avenue NE
572-0635
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Quality #1 Plumbing & Remodeling 1670
132 Ln NE Blaine 55449 755-5198 7640
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 ❑ REPAIR ❑ MOVE ❑ REMOVE
1�
8 DESCRIBE WORK
Construct a 10' x 12' 19= Addition to
Dwelling
9 CHANGE OF USE FROM
TO
STIPULATIONS
See notations on plan.
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 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
$6,945.60
$3.47
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-
CON-
$124.75
Fire SC $6.95
STRUCTION THE PERFO CE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
C.r �! 2 S' (o
License SC $5.00
$140.17
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
VALIDATED THIS IS YOUR PERMIT
�W�HENPROPERL
YRSv ��
a
6L INSP GATE
SIGNATURE OF OWNER 0F OWNER BUILDERI IDATEI
1+
01
NEW [ ]
ADDN [) CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress: Z e-1 o 6P7 f
Legal Description:
vZ N115-
Effective 3/ 96
1
Owner Name & Address: T•erL24 � Gajz r3 GL-i..i r Tel. # S 72 a6 �S
Contractor:j!�jPoi+t, j, 1+1 PI.��,S,..sao�c�P� MN LICENSE# 7(oy0
Address: 1(,70 / ,32-.o Tel. # '7SS- - SI 9 P
Attach to this application, a Certificate of Survey of the D C
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF E"ROVENWM
LIVING AREA: Length 10A Width /2- Height Sq. Ft. I L. O
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: s',u a r-,94 1,1 (z e s. Estimated Cost:
Approx. Completion Date: 9
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft. = x $ _ $
DATE: 1Y -r 9 - 9 APPLICANT: r Tel. # ;7 S'S` - 5-/ 9
CITY USE ONLY
Permit Fee Fee Schedule on Reverse Side
Fire Surcharge 4.qs $ .001 of Permit Valuation (1/10th%)
State Surcharge 3. y j $ $.50/$1,000 Valuation
SAC Charge $ $900 per SAC Unit
License Surcharge $ S DD $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Pian Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary j ] Not Necessary [
TOTAL $
STIPULATIONS:
INDUSTRIAL
BUSINESS
CITY LOTS
TOPOGRAPHIC MAPPING
C. E. COULTER
LAND SURVEYOR
REGISTERED UNDER LAWS OF STATE OF MINNESOTA
LICENSED BY ORDINANCE OF CITY OF MINNEAPOLIS
3300 LYNDALE AVE. SO. MINNEAPOLIS 8. MINN.
TAYLOR 4-0370
�'vk'Y=r Fes.<,' t`,;� 's�'. ��•�•;''
��rtrr��.r'a �igrtit�rure
6
m
I
N � 13$ •!1
I\ \d PLATTING
FARM SURVEYS
LAKESHORE
JUDICIAL
I.
i
9i
4
I hereby certify that the above is a true and correct 1-11at of a ;urvev of-,
Lot Seven (7), Block Five (5), R1C1: c;FzELK ULa`jA SuTTV, ADDIT101., Anoka County, D''innelaots.
As surveyed by me t.lis 1st day of f�',ay 1G58 A.
aJu" t.inne.scta,. Registration No. 2584
SUBJECT
P2
City of Fridley
2 4
AT THE TOP OF THE TWINS
BUILDING
PERMIT
Ir
RECEIPT NO.
• _ COMMUNITY DEVELOPMENT DIV.
v PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV -
PAGE OF
APPROVED BY
612-571-3450
910-F15
IDATE
5/30/96
/ /
JOB ADDRESS 240 67 Avenue NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
7
5
Rice creek Plaza South SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Terry Clint 240 67 Avenue NE
572-0653
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
D & D Home Improvement Inc 7401 Central Ave NE, Fridley 55432 784-7543 4840
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 ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Reroof House & Garage (19 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the 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
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 I 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
$.76
WITH WHETHER SPECIFIED HEREIN OR. NOT. THE GRANTING OF A PERMIT
$1,520
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIOANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTI HE PERFOR OF CONSTRUCTION
$51.25
Fire SC $1.52
NOR CE
PLAN CHECK FEE
License SC
$5.00
TOTAL FEE
$58.53
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATr1-
WHEN PROPER
VALIDATED THIS IS YOUR PERMIT
33
SIGNATURE OF OWNER OF OWNER BUILDE RI IDATEI
aLCAV INSP
GATE
NEW C ]
ADDN [ ] CITY OF FRWLEY
ALTER [ ] SINGLE FAMII,Y AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress:�
Legal Description:
Effective 3/1/96
*'�) ��_5z
Owner Name & Address: �,��� ��/�/ Tel. # 7;1 _
Contractor: D & D Home Improvement, Inc MN LICENSE # a R a n
Address: 7401 Central Ave NE Fridley, MN 55432 Tel.# 784=7543
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF HNAPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
_
Type of Construction: Wig) -Estimated Cost: $ 1& 20
Approx. Completion Date: 7TAW
.(Cost on Back)
Driveway Cuyb Cu
Width Needed.:
Ft. + Ft = Ft x $ _ $
DATE:
APPLICANT:
Tel. #
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$ / S
.001 of Permit Valuation (1 / 10th %)
State Surcharge
$
$.501$1,000 Valuation
SAC Charge
$
$900 per SAC Unit
License Surcharge
$
$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 [ ]
TOTAL
$
STIPULATIONS:
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 January 1, 1997
PLUMBING FIXTURE RATES:
NO. RATE TOTAL JOB ADDRESS_ 4410 ip %' A V, /V C,
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 fads
Blow Off Basin
$ 7.00
and -representations stated in this application are true and correct.
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
&ZOIL.1998
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
-
Owner �4 7 7r6"Y Y-,�/�A�/
Water Heater -Electric
$ 7.00
Water Heater - Gas** l
$10.00
Building Used As
Gas Range"
$10.00
Gas Dryer**
$10.00
Estimated Cost PERMIT NO.
Back Flow Preventer Required ( )Yes () No
Type
$15.00
PLUMBING COMPANY76�
Reinspection Fee $42.00/Hr
SIGNED BY TEL N0.o�%`�� l �t
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Facture or Appliance
Approved By Rough -In Date Final Date
-4
State Surcharge
$ .50
G
TOTAL FEE kgl D PLUS THE $.50 STATE SURCHARGE
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES.
Building
Inspections
763-572-3604
763-502-4977 FAX
SITE ADDRESS oC' t I
THIS APPLICANT IS:
PROPERTY OWNER
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING Di
SIZB OF IMPROVEMENT
BUILDING Permit No.:
RESIDENTIAL APPLICATION. Received By:
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
-il F,
❑ OWNER NTRACTOR
NAME:
ADDRESS:CT
a4 •o —( �,
PHONE: 7W 5 —7a - (o s 3
NAME
ADDRESS• 1
PHONE — q6p
STATE LICENSE # /?
+SINGLE FAMII,Y N S:
❑ TWO FAMILYINEW CONSTRUCTION S
❑ ADDITION ❑ GAI2AGP/SFIED
❑ BASEMENT FINISH ❑ ROOF
D DECK ❑ SIDING
❑ SWIlVIlAING POOL
❑ NEW HOME CONSTRUCTION ❑ ADDITION
WMAIN1`ENANCE/REPAIR ❑ REMODELING
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS ✓-
IN EXISTING OPENINGS ikes ❑No
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
EXP DATE Z
❑ DRAINTILE
❑ OTHER
❑Sofrt .I- 3ji;& - L-� Rxx-)
C4,11 ra*'Vo
❑ Fascia 3 _ � ' �../► �'O-�
LOCATION OF WINDOWS
W
—Na
_ nmu ff i, SQ FT a
I3ASEMENT REMODELn'40 SUBMIT:
L Existing Floor Plan
. 2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDMONS & PORCHES =.
I. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
3. Enargy Calculations
I r rn vr. W uvLV W I V .= mail,AU.&D
NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING� 1997 UBC FEE SCHEDULL)
DOTAL JOB VALUATION $
Q�. OCCUPANCY TYPE
Permit Fee
$
/.5, Aly See Back Page for. Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$ Q _ .001 times the total job valuation
Surcharge
$
-3-90 .0005 x Permit Valuation Minimum $.50
License Surcharge
$'
15.00 (State Licensed Residential Contractors)
SAC Charge
$
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Curt Escrow
$
ft + 6 ft = ftx $21— $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
&Make checks Dayable.tw City of Fridley Attach St3unlatinac
THIS IS AN APPLICATION FOR A PEUdIr 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 codas
of the City of Fridley and with the Mimtesota nstnrction Codes; that understand this is not a pannit but only an application7�f f permit and work is not to start without a
permit on side; that the work will in acco ce the approved m the case of all work which requires h``'aw [� / J
SIGNA 0 PRINT NAME �Jl�i DATE (• l [o f D
Building
BUILDING
$
Permit No. a O
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
$
.001 times the total job valuation
Surcharge
$
CITY OF FRIDLEY
Date Rec'd:
763-502-3604 FAX
e�( $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2100 per SAC Unit (Plans to MWCC for determination)
EFFECTIVE 1-1-2010
$
ft + 6 ft = R x $24 = $
�9 J/ /�}
DATE '<! ' ! V YOUR E-MAIL ADDRESS
$
SITE ADDRESS c9�D
Park Fee
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
Fee Determined by Engineering
PROPERTY OWNER/
NAME: Ir'Sj C�UM+
— necessary ( ) Non Necessary ( )
TENANT
�/►
ADDRESS: 2YC l0 - 04,,,, CITY
Col
r' -'A STATE /hy✓ZIP
PHONE:
CONTRACTOR
NAME:Cyr-►,..a..-,
SUBMIT A COPY OF
STATE LICENSE # Q �O
EXP DATE " Z401 7-
YOUR STATE LICENSE
�-
AND CERTIFICATE OF
ADDRESS:
CITY (-in, +-. L, lc t STATE ,,)ZIP� .5VLf
INSURANCE
PHONE (03 - YLIS - ((0'5q FAX -7(-3 - 7 m - l d3
PROPERTY TYPE
O$INGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION GARAGE/SHED
❑ WINDOWS
�❑
❑ BASEMENT FINISH P!9ROOF
❑ DRAIN TILE
❑ DECK ❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAIINTENANCEIREPAIR REMODELING
DESCRIBE WORK BEING DONE: IC 2 I Luh
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT SQ FT
ROOFING 17 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
FOR WINDOWS - PROVIDE U -VALUE AND
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
MANUFACTURE STICKER ON WINDOW.
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 $ OCCUPANCY TYPE
Permit Fee
$
D See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$
_�'� 0005 x Permit Valuation Minimum $.50
License Surcharge
$
e�( $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = R x $24 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$Agreement
— necessary ( ) Non Necessary ( )
Total Due
$
Make checks Davable to: Citv of Fridlev Attach Stiuulations
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 fo 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 whi require view and approval of plans. ,j
SIGNATURE OF APPLICANT PRINT NAME i� &,C<J I DATE /0 l D