PRE 2010 DOCS•
City of Fridley, Minn.
BUILDING PERMIT
Date: May 25j, 1965
William Backstrom
Builder
(�194
N° 7515
Nilsen Erickson Inc.
Address ____V2 — 6M, Ave- N. E. Address 7632 TnT,�t1;. St.
LOCATION OF BUILDING
No. 572 Street 67th. Ave. N. E. Part of Lot
Lot - 2 _ Block _ 7 Addition or Sub -Division Rice Creek Terrace Plat 4
Corner Lot _ Inside Lot _ Setback Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Rssiftuce Front — Depth Height Sq. Ft. Cu. Ft
Front Depth Height Sq. Ft Cu. Ft
Type of Construction Frame Est. Cost S2 9 7QQeO-Q_ To be Completed
Storm Damage Repair
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 a& provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of$ 0•�, permit is hereby granted tr, N� el®on Inc*
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 location, construction, alteration, maintenance, repair and moving of buildings
within � city limits permit may be revoked at any time upon violation of any of the provisions of said
NOTICE:
Ibb permN dost not eewr the conttruetlon, lnttdWon for wiring, plumbing, gas healing, sower or water. Be acre to we
do Bulldlog bupaetor for oparate psrmih for thaw Nems.
V
APPLICATION FOR 1NG PERMIT
CITY OF FRIDIJY0 MWZMA
OWNER' S NAMEo BUILDER /Ilii �974)l�i
ADDRESS' 6 7 %Z[ - if E A46 ADDt�ESS
�_.
LOCATION OF BNG
No, _'�� .. Street 'j< 4&E O . Jlart of Lot,,..
Lot �- Block Addit.ioar or Subdivisiaq�
Corner Lot Inside Lot _...SetUack Side-Yarq.
SEWER ELEVATIQN FOUNDATION
Applicant attach to this form, Two Certificates of. Survey of Lot and propcsed'tr t,�
ing location drdwn on these CA-ttificates.
To be used as: 6F."iD EstiC>
DESCRIPTION OF BUILDING
-PronC Depth Height'.
r . i � s
S$. Ft. Cu. Ft.
Front Depth Height
StJ. Ft. Cu. Ft.
Type of construct LOU . _ Estimated Cost
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work Id strict accordance with the City of Fridley Ordimnees and
rulings Of the Departz�n of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
r✓
-of Fee Coats can be found on the Reverse Side).
City of Fridley, Minn.. N° 8539
BUILDING PERMIT
i
Date: OCTOBER 193 1965
0
L
per: WILLIAM BACRSTROM Builder ML.SEN-.ERTCBGON. INC
Address - 572 - 67th Avenue N. E. Address 7632 Nest 14th Street
Fridley 32, Minnesota Minneapolis, Minnesota
LOCATION OF BUILDING
No. 572 Street 67th Avenue N. E. Part of Lot
Lot 2 _ Block 7 Addition or Sub -Division .___ Rice res Terrace,
P7 a fi 4
Corner Lot Inside Lot — X Setback _ _ Sideyard
Sewer Elevation ____ — Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
DET. GARAGE Front 20 Depth 22 Height 8 Sq. Ft�/ 0 Cu. Ft _ 3.52
Front Depth freight Sq. Ft. Cu. Ft
Type of Construction Frame Est Cost _ 1.aQ...9_ L- 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 aft provisions of
ordinances of the city of Fridley. F
In consideration of the payment of a fee of $ 4.00 , permit is hereby granted to NILSER-ERIMON, INC.
ress
tto construct the building or addition as described above. This permit is granted upon
he expcwndition that the �e�on to whom it is granted and his agents, employees and workmen, is all work
done in, around and upon said building, or any pi�art thereof, shall conform in an respects to the ordinancres of
Fridley, Minnesota regarding location, conatructton, alteration, maintenance, repair and moving of buildings
within the city Iimits and tb�s permit may be revoked at aqv flans upon violation of any of the �^ovl�ons of said
ordinances.
ALLEN G. JENSEN Building Impeatcr
NOTICE
M pemb dos trot cover the com rue9m, keWhdon for wkb* plumbing, on hodiso, ower or wabr. Be sm to M
the ouiiding hupector }or opmate pwmHe for thea Nemo.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME XZLLiA W / f KIST //4 BUILDER/l d S �' �1�� /C IA` -r✓ `1.G¢",
ADDRESS_
LOCATION OF BUILDING
Street j -y ld Alf , Part of Lot
-LOT R ADDITION OR SUBDIVISION
Corner Lot Inside LOT-4—SetbackSide-Yard
SEWER ELEVEN FOUNDATION ELEVATI011t.
Applicant attach to this form Two Cettificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as:
- A `011 `i Front Depth, Height j -�O `P
Sq. Ft. Cu. Ft. .3 S
Front Depth _Height
Sq. Ft. Cu. Ft.
Type of Construction���,(L�� r 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 Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
DATE ��`9 / j -- SIGNATURE ��e��L�P eZ F,, -,t .
(Schedule of Fee Costs can be found on the Reverse Side).
., 9 .
01
SUBJECT
PER
City of Fridley
2 9 09 0
AT THE TOP OF THE TWINS
BUILDING PERMIT
COMMUNITY DEVELOPMENT DIV.
f � � PROTECTIVE INSPECTION SEC.
144
I /"'1 CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED By
.......
�'' 612-571-3450
910-F15
3/26/99
JOB ADDRESS
572 67 Avenue NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
7
Rice Creek Terrace Plat 4
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
William Backstrom 572 67 Avenue NE
571-3461
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
B & B Roofing 6760 Madison St NE. Fridley. MN 55432
571-0248 9042
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage 25 SO Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building
Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
SEPARATE PERMITS ARE REOUIRED 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
S0. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2,142
$1.07
DOES NO ESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVI. ONS OF ANY OTHER ST OR LO L L REGULATING CON-
$74.75
Fire C $2.14
STRUJ'CTIO OR THE PERFORM CE OF, STR TION
� �2
LZ
PLAN CHECK FEE
TOi EE
Lice SC $
$82.96
SIGNATURE OF fONTRACTOR OR AUTNORIZED AGENT IOATEI
HEW ROPE A 10 1THIS IS P IT
SIGNATURE OF OWNEROF OWNER SUILDERI (DATE,
BL INSP
fIA1E
01
NEW [ ] Effective 1/1/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description: _� ��v i/)� 1-1 L—
Owner Name & Address: Z -G / LGr��/—
Contractor: 13 6- MN LICENSE # Cf� � —
Address: Z22d f --'0Y1 s -i Tel. # --S-
Attach
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
Construction Type:
Estimated Cost:'$ C� c�� C
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft.
+ 6 Ft =
Ft x $
_ $
DATE: APPLICANT: (
; "�' ° -�
Tel. # �X
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
$1050 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, 1999
6431 University Ave NE :
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
HEATING COMPANY 41;1e2l0l;w /)`P�7/iag V -
MINIMUM FEE FOR ANY HEATING/COOUNGNENTILATION
REFRIGERATIONIAIR CONDITIONING PERMIT IS $25.00 Signed By � G Tel No. h a- 7r0- 3 k -P
PLUS THE $.50 STATE SURCHARGE L` \QIL
REINSPECTION FEE $42.00/Hr Approved By ..,& Rough -In Date Final Dat
*Air Conditioners can not be placed in a side yard without FILL OUT BACKSIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
written permission from adjoining property owner.
JOB ADDRESS J TZ 67-114 AUS
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work herein
Residential
Rate
TOTAL
specified agreeing to do all work in strict accordance with the City Codes and
Furnace Shell and Duct Work, Burner -
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Fumace
$ 30.00
$ �D
representations stated in this application are true and correct.
(Side Vent - Fill Out Back)
Gas Piping (Needed with new fumace,
$10.00
$
1 111,,,, dock
but not replacement)
OWNER W S'4 2 a ,
Gas Range
$10.00
$
BUILDING USED AS 2e S t -2>e N S e
Gas Dryer
$10.00
$
ESTIMATED COST _� 70®00PERMIT NO. / 7 /
*Air Conditioning - All Sizes
$ 25.00
0 0
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (UST ON BACK)
1 % of Value of Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Aid
Trade Namely p2,c AN Na&q�,,�t Size No. -?47-oo.jR �o
Commercial/Industrial
BTU 7S ®ego HP J V3 EDR
1.25% of Value of Appliance or Work
$
Fuel Q,c Total Connected Load % 0 3.2 o a
State Surcharge
$ .50
Bumer Trade Name Size No.
TOTAL FEE
$ 551, SSC
BTU HP EDR
HEATING COMPANY 41;1e2l0l;w /)`P�7/iag V -
MINIMUM FEE FOR ANY HEATING/COOUNGNENTILATION
REFRIGERATIONIAIR CONDITIONING PERMIT IS $25.00 Signed By � G Tel No. h a- 7r0- 3 k -P
PLUS THE $.50 STATE SURCHARGE L` \QIL
REINSPECTION FEE $42.00/Hr Approved By ..,& Rough -In Date Final Dat
*Air Conditioners can not be placed in a side yard without FILL OUT BACKSIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
written permission from adjoining property owner.
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CHIl MY AND STACK VERIFICATION
The
undersigned. hereby verifies that the existing chimney or stack:
a
L
Has been carefully examined
Yes No
( )
2.
Is free from rust or deterioration
Yes No
(- )
3.
Has no foreign objects lodged within
Yes No
( )
4.
Is securely supported
Yes ("S No
( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes (v� No
( )
6
Has total heating BTU's of p 3 200
All other BTU's
TOTAL BTU's 16 3 2_0o
7.
Has a liner been provided for water heater
Yes ( ) No
(✓f
8.
Has combustion air been provided for water heater
Yes ( ) No
(,I�
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
G7YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
October 17, 2001
Mr. William Backstrom
572 67 Avenue NE
Fridley, MN 55432
Re: Final Inspection at 572 67 Avenue NE
Contractor: American Heating & Air Conditioning
Dear Mr. Backstrom:
A mechanical permit was issued on June 3, 1999 to install a furnace and air conditioner at your
address. According to section 305 (a) of the 1991 Uniform Mechanical Code, a final inspection
shall be conducted on the mechanical work authorized by this permit. As of this date, no
inspection has been called for.
The permit fee'that was paid covers the inspections to make sure the work was completed
according to the Mechanical Code. We will keep your permit open for another 30 days and if we
do not hear from you within this time to set up the inspection, we will expire the permit and no
further action will be taken.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
CITY OF FRIDLEY INSPECTION DIViSION
Effective On May 10 1999
6431 University Ave NE
Fridley, MN 55432 APPLICATION
G6,,/1
FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 6C���6 A
572-3604
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES �.
JOB ADDRESS :Z
RATE SCHEDULE
OWNER
Residential
Rate
TOTAL
"
Furnace Shell and Duct Work, Burner -
BUILDING USED AS
Also Replacement Furnace
$ 30.00
$
ESTIMATED COST 64 PERMIT NO.
(Side Vent - Fill Out Back)
o3
Gas Piping (Needed with new furnace,
$ 10.00
$10-60
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNER
Gas Range
$ 10.00
$
No. of Heating Units_L— Circle One (Steam) (Hot Water(Warm Air
Gas Dryer
$ 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
j.25% of Value of Appliance or Work
State Surcharge
TOTAL FEE
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.
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 without
written permission from adjoining property owner.
J . .
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes ( No ( )
2. Is free from rust or deterioration Yes No ( )
3. Has no foreign objects lodged within Yes No ( )
4. Is securely supported Yes( W No ( )
S. Meets all current Code requirements for size
and total BTU's connected Yes (X No ( )
6 Has total heating BTU's of d,
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes Q0 No ( )
8. Has combustion air been provided for water heater Yes ( �5 No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By: •t—�- ��v\
Date: 2 ? 1P 9
I
CIIYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287
August 9, 2000
William Backstrom
572 67 Ave NE
Fridley, MN 55432
Re: Final Inspection at 572 67 Ave NE
Contractor: Fireside Comer/Allied Fireside
Dear Mr. Backstrom:
A mechanical permit was issued on May 27,1999 for the property located at
572 67 Ave NE to install gas piping for a fireplace. According to Section 305(a)
of the 1991 Uniform Mechanical Code a final inspection shall be performed on
the mechanical system. 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 (763) 572-3603.
Sincerely,
DAV NSEN
Build' g Inspector
SUBJECT
City of Fridley
313 2
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r
1
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
AOP110VED By
612-571-3450
910-F15
8/21/00
JOB ADDRESS 572 67th Ave NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
7
1 Rice Creek Terrace Plat 4 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
William Backstrom 572 67th Ave NE (763) 571-3461
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Norling Exteriors, Inc. 341 79th Way NE Fridley, NIN 55432 763 784-8936
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
20098700
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION 10 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside house $ garage soffets and facia and trim
9 CHANGE OF USE FROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather
resistive barrier be place over exterior sheathing to protect the interior
wall covering. Exceptions for this provision would be if sheathing is an
approved weatherproof panel or when the siding is an approved weather
barrier. Vinyl siding is not a weatherproof covering unless the manufacturer
states this in their application guidelines. Call for inspection of wrap
before covering.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$ 648.00
w4. 32
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR OCAL LAW REGULATING CON-
STRUCTION R THE PERFORMANC OF NSTRUCTION
] 67.25
Fire C $8.65
/�
ter/
PLAN CHECK FE
TOTAL EE
Lice S S.0 ;'
.22
S.GN4TURE 0F CON'RACTOR OR AUTHORIZ/5 AGENT 104TEi
N R E ALIpAT D $ IS,,TJft PE ITj
r
S-GNATUAE OF OWNERi19 OWNER BUILOER. ,DATE,
Bl NSP MATE
NEW [ ] Effective 1/1/2000
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp -
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: � -� '�' G � ���. 6
Legal Description: S r na k- &..,n r L
Owner Name & Address:
Contractor. N e., r-
7
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
W
Tel.#
MN LICENSE #
Tel.#
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
Construction Type; t✓ -P- 3 cfersstnated Cost: $ - y
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: '(^ a APPLICANT: 44A Tel. # 7C- - .ate 72 - 12
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
`tiWOI
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
Fee Schedule on Reverse Side
r
$ r) . .001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$ $1100 per SAC Unit
$____S - 60 $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 [ ]
$ 13
s ..