AF - 35375.. .... . r#:. '�. . a Ma. ......jy � i� r . .y . - . .. . � � ... . .. . . . :. . .. .. . . .. . �
. � � sueaecr - PE . .
City of Fridley _ 'I6533
ATTHETOPOFTHETWINS �BUI�D��.� PLR�IT�
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� �_L .� ���_ � � COMMUNITV DEVELOPMENT DIV. ' � - � 5 � 9S^' � :
f � � - j � � PROTECTIVE INSGECTION�.&EC. . � � - � . � .
� t� �` �"9 � qTY HALL FRIDLEY 55432 MUMBER REV . DRTE � PAGE oF �� aaaeoveo er .
""� � •�� �.. 612-571-3450 � 910-F15 .... . . . .
�aa/s2 / /
106 AD6RESS ... . .. � . � ' � � . � �
7651 Arthur Streef N.fi.
�� 1 LEGAL�� LOTNO. � BLOCK ��� � �� .�TRACTORADDITION .. ' � SEEATTACHED � �
bE$Cfl�. �.13. � i .� � � .BLO�@IQ.H+'Std%e5 � SHEET . � � .
. 3" PH4P6RTV 6N!lyEA: � t, � - . .MAIL ADDRESS � � ' ZIP PHONE � � �
��`�'� �-. � ��nC.� ` 481 -��20bt,h Avenue�N.E.. Cedar;� b5�1,� 434-7096
'-p 3 TOB �"- � � � �.MA{LADDRESS � . '��'?Z�P �PHONE LICENSENO. � ��
.S � � . . . ... . .
A ARCHITECTOR��ESIONEH MhILA�pAE88 � �n���.` r�L�U�IRtiU � E- � � NSENO. . �
Irl J �L{� ZSL
�5 �BR � MAllAODRE$S�� ` ����y�'�A_, PHONE � .LICENSENO., � .
ING. AKav �i
� 6� USEOFBUILDING', � � . � . �. �� . .
^' � �A�Q�w� ��� � C� NEW ❑ ADDITION ❑ ALTERATIfYN ���� ❑ `REPAIR ❑ MO � ❑ REMOV6 �
u.•_.. , .. . . . .. . . � .
e oESC �� ,
(bii��ruct 3> 4�' x 26' Dwallinq and a 24' B" s 21!>;�Oarage Beiare di '
or�F-E�€cr�rc. n+r � s
c�� Et ,
' ' 9 CMAN{#E OF tdiE RHQM . . . . . . . . TO ... � . � .. S �/ �� - ..
3- �
57fPUVS7i(3tt& �,��� a haxci sur�ace driveway, Provi.de A verifying si�vey before
cappinq'fpundation. Provic� sod in the Pront ahd�side yards. I�re-tr82
a �- . � * � } -� ' '- :� Contxol e�fSS�rl sand fYOm blowing off
lots o�'��iXe project.
, "' � �� � � � �
„ :
3,AG2�T�9D1 (13' + D�aP In Stseet) 64' S. a�,�H. iinv. 84L24)
� � ���� ': �o.§� �:� aF F€xrraxc: s�a.00 �im�� ��
WA',�$R iACATIp�:,AgpYOx. i9' N. of Sewer SerV€�:.54� S. of M.H.
�tiVEWAY DEPRES3SON: 16' -l� fi' = 22' x$13.50 �. �247.U0
UtY ;t� 1'RlRLEY �OBS NOl Gil>4�`.:a1E„
_J�.,'��tl'+�#� -t1T±1:'�' ?�+CA7iCNS As�t� ...�:i:.:
, t�A7'A�-{-la�y�F�.w�F�?:�?: .i:;ledSiG1J nta .i t"�f i. !`r :.
_ . . . 11;5 �^�F �S�rtrSNR.!' �3 � �:.`F�L t �: � �J,'�: ��r '.L :° "`k
1l14"
� � Pf�t3i OCCUPANCV�G90UP OCCUPANCYLOAD�'
� SEPARATE PERMITS ARE REQUIRED FOR ELEC�N�CAL, PLUMBWG, HEATING, ' � � . � �
. VENTILATING OH AtR CONDITIONUd6 � - [Qpq�. ��- $,`s � � .�
� THIS PEAMIT BE6`AM€S kLLtO AND VC}ID IF WORK OR CON$TRUCTION Z(#tAN . ; .., gp¢FL .� CU. FT�. -
� AUTHORIZED IS NQT CAMMENCEO WITH7N 80 DAYS OR IF GQNSTRWCTION�. 4, ' � � � . .
� OR WOFKi6 SL6PEN�ED OR ABAN�ONEO FOR A PERIO� OF-f�O pAVSAT �.�.,�LO�.O + rJ�4 �� �
. . ANV TIME'Rfi�ii WOpX IS CQM4M�l�tEO: "` �'� ND OWLGr-UM1T5 � OFFSTREET PARKING� '. � �
I HER¢$V'F�&iIFY7Hi�T I NkyE REAp AND EXAMINED�THIS�APPLICATION � S�'�. - SFALLS � � .GARAGES . - .
� � ANj�lt�ttlHidTHB$AMEiQBETRUEANDCORflfCT.�ALpPROVlSIONSOFLAWS yA4UATfON�r �� � �SUBTAX � �
� AT{EY`.O3iq�NA $ G6V@PNiNG TMf3 TYPE OF WOAN WIIL BE COMP��ED � � �
WITH WH@TNER �PEGIFIED HER�IN OR NOT. 7NE�GflANTING OR A PERMIV S49c9OQ . ySZ�.9S .
. DOES NOT PqESUME 70�GIVE AUTHOAtTY TO VIOLATE OR CANCEL TNE pEflMITFEE�,f ��� -�SACCHARGE ' �`'.'.
� PROVISIOM Of ANY�-0THER STATE OR OCAI 4AW REGULA7ING CON- � � � �� �
� ST� CTIO R Ttf�':PEFFORMdNCE OF C NBjf1UCTION � � � S�3.d� �� vS�2S�• OO �
VLA CHECXf ' TOFAIPEE '
Q.. . � .. .. . . ..
� $95.75 $92$.70.
51GNA1uRE0f CON PaCTOROAAJTn ¢EO�GFNT� IOATEI -:. WHEp1 R4Y VALfOATEO TMI$ IS VOU�7 PERMIT '
�,
HATUH NF �IiOWNERBUiLDEN� �DnTE� BLDG iNSP � aiE �
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'� `�vl����r��y��, �' � a� � �` � � .' � �'� �, w< � �; � � -`
SURYEY FoR = G.�.Ra�c CotrsT Ruc,'C\ON
LF$1' 206-rH �vE. NE.
CeDACZ, MN. 55011
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DF.SCRIPTION
Lot 13, Block 2, Blo�nberg Estates, City of Fridley, Anoka County, Minnesota.
SCALE: 1" = 40
o Denotes 1/2" diameter iron pipe monument set and capped t�o. I0832� on
� • Prno+cn ,.-_.. .,.o.,.,..,�-.+ ie.,..a - ' Ido... tz, t4Ho
I hereby certify tfrat this survey, pl•an piat,preliminary plat or report ���s prepared by me or under
my direct supervision and that I am a duly Registered Land Surveyor under the la�+•s of the State
of Minnesota. /�
. I'�EZi2 . �✓oUEMl�OCZi/�ISL 4540 �i6��-•Z8
�� Reg. No.. Date Job No. Book No.
�
Surveyors Certificate
GOMSTOCK & DAVIS, INC. ' Consulting Engineas and Land Sucweyon
iaas co�,�y x�a J, Mimeapotis, MN 55432, (612) 7549346
SURVEK FOR:
B & G Investments
961 Hillwind Road
Fridley, Minnesota 'S5432 "
C
DESCRIPTION
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Lot 13, Block 2, Blonberg Estates, City of Fridley, Anoka County, Minnesota.
SCAI.E: 1" = 40
O Denotes l/2" dianeter iron pipe monument set and capped:No. 10832.
I heroby certify that this survey, plan or report was prepared by me or under my direct
supervision. and that I am a duYy Regstered Land Surveyor under the laws of the State
of Minnesota.
r w^� �� 10832 , Nov_ 17_ 1980 4278 9 •
Reg. Na •� Date Job Na Book Na
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QWI{ER:
ADDRESS:
7EL N0:
CITY OF FRIDL[Y Effective Auq. 1, lasl .
' ��9�t L
APPLICATIRJ FOft R[SIDEi4Tllli_ [3UILDIi1G PL•RHfITS �
(Nc�v, Alterations, AddiLions, or Repairs)
13UILDER: �n�iRJ�C /NC-
�
nn�ess: �/�'/ �2a �,�. A✓P ,�/i'
TEL FaO: �,� y—'% D q�
Construction Location
ST7i13iR t�: (O� STI2EET: /��T� �% ' ` � ,v �
7AT: _ %3 SLOQC: 2 ADAITION: ��oP/h�ja? 4 � ��%���
Corner Lot: _�_ Insii3e Lot: Setback: 3� Sfdeyazds: .�3
Apislicant attach to this foxm two Certificates of Slizvey of lot and
pzoposed buildiag location drawn on certificates to scale.
;DESCRIPTIOid OF COUSTRUCTION
,< /
S� Tront: y� Depth: �1� Neight: �
Square.�eet: JD''lU A�bfc Feet:
.��}2ri� F Front: Depth: Beigl�t:
• Squar.e FePt: CVbic Peet:
Rype of Construction: �/(/�/YJ� Estimated Cost: $�4�%
�
'lb $e Wnp2eted: '�"��i3• � A1�A Alt. B
/ I � r��-�y�
Proposed Drivcnaay width If New Opening Is Desired: /_ C[� � $ g_G� -�
. . S�� J�VERSE SIDz OF SHEET
RSie undersianed hereby makes application for a pe�it for the �•�rk herein specified,
agreeing to do,all work ir� strict accordance rrith the City of Pridley Ordinances and
rulings of the Delk�rtment. of Duildinqs, and hereby declares tha all the facts and
repres�ntzttions stated in this applicatio are true and correc .
nam�: �— ?�_, sicNn�ne: -----
Stipulations:
p�.�' _ 3$3,0�
P e a S, ���
'fY � V ,9�
� t,�zS, n�
fN:w, a�, °"
. «25,� o
� fZr�m�u��,, �rcz�r�L cJ�B�.►S F4�e�+�.
U Jac.+ANC C.c�L GnJ (.rA�GS� �A�C
� Cu�Jcvt.dL. �� 59.�10 F'r:e�
�c.a�i.►� o�f� l.o� � �aTu�G
1�a.���-;
BUILDIPiG PERMIT FEE SCHEDULE
The Inspector of buildfngs shall, before issuing permits for the
erection of any building or atructure, or for any addition to any
bxisting buil8ing or stzucture, or for any alteration or"repairs
to any existinq building or structure, upon application therefore,
require the payment by the applicant for such permit of iees to the
amount herein below set forth and in the manner herein provided to-wit:
TOTAL VALUATION
¢1.00 to 5500.00
$501 to 52�000
$2�001 to $25.000
$25,001 to 550,000
FEES
510.00 Minimum Fee 515.00 plus surcharge
$10.00 ior the first 5500 plus 51.50 for each
additional $100 or fraction thereof, to and
inclading $2,000
S32.50 for the first $2,OOD plus $6.00 for each
addiiional $�.000 ar fraction thereof, to and
fncluding $25,000
5170.50 for the first $25,000 plus 54.50 for
each additional $1,000 or fraction thereof, to
and including 550,000
550,001 to $100,000 $283.00 for the first $50,000 plus 53.00 for
each additional $1,000 oz fraction thereof, to
an8 including $100,000
$100,001 arid up 5443.00 ior the firat 5100,000 plus $2.50 for
each additional $1�000 or fraction thereof
PLAN QiECK: 25 percent of bui.lding permit fee
�tIVtS7AY DEPRESSION ESCROW: Concrete G1irh Streets �ly
Alternate "A": Removeal and replacement of gutter only
Driveway vidth plus 6 feet" $13.50
Alternate "8": R�oval and replacement of d gutter and install a 3 foot
wide approach with 6 inch depth
Driveway width plus 6 feet x 515.75
VERIFICATION OF FOUNDATION
Permits for construction will be iss�ied a minimwn of 24 hours fr�u the time of
applfcation to allow for proper review of the proposed structuse and of the
constm ct3on site.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed r+ill be required before �roceeding with.the framing.
f,-..
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CITY OF FRIDLEY
1181 UNIVENSITI AYENUE N.E., FRIDLEY, MINNESOTA 5.5�9Y
?ELEPNONE ( 612)571-9�50
Septaober 17. 1982
Garjac inc. � � �
481 - 206th Avenue N.E.
Cedar, NIl9 55011
Re: Final Znspection at 7651 Arthur Street N.E., Fridley, t�SI
Dear Sirs:
A final inspection was made on September 16, 1982 on the above xwted
address and the following items were noted which must be completed
before the structure can be finaled out:
1. Pmvide sod in the front an3 side yards.
2. Prwide the City with a copy of the verifying survey.
The City has also rat re.ceived verifying suxveys for 7521 Arthur Street,
7651 Brigadoon Place, 7550 Brigadoon Place, 7628 Brigadoon Place, and
7571 Briqadoon Place.
We will expect the above items to be completed and a reinspection
called for before occupancy. If you have any questions on these items,
please feel free bo contact me at 571-3450.
Sincere ly ,
DARREL G. CLARK � �
Chief Building Official
DGC/mh
ADDN [,.j •..� - _C1T� OF FBIDI.EY ; - -
ALTFR [ I SIl�iGLE FAMQ.Y AND DUPI.E7�S R-1 AND R 2 \
BUII.DING PERhIIT APPLICATiON ����/
' �`7
coffiauc6on,a,dclress: �1(,5 i 1�1'`�-�'l,�r S'�f�re.e_+ N F � 10
Legai Description: n
Owner Na� & Address: �a--Yl Tel. # / �s �-�3?3-
Con�actor. _ j�Q � l� �� r� v, -.1"Yl � ����SE � aooq 3c� 9S
�,aa�:91G9 C.en-�ral �-ve N� Bl�ine. 5�3� Tei./i �%�- 0'f]�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
1 y. ' 1' 1 • I 1' '• �I�I .►M
LIVING AREA: I.ength Width Height � Sq. Ft.
- — _v-- ----- ---- , �-- -- - -- - . � s
GARAGE AItEA: Length Width Height Sq. Ft. _
DECB AREA: Length Width Hgt/Gmund _ Sq_ Ft. _
OTSER:
070 k�S. 7C�
Construcdon TyPe: �Q,Y 6b � �� . at, Fstimated Cost: $ ��% f y
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: _Ft. + 6 Ft =_Ft x$ _$
DATE• �-�� APPLICANT• (X�/1/ Tel. /f � I% Z�%�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
Licease Surcharge
Driveway Escmw
Erosion Control
$ �P, �i
$__���
a
$�
$
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuatioa (1/lOth`%)
$.50/$1,000 Valuation _
ai000 �r sAC u�c
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
5450.00 Conservadon Plan Review
Park Fee $ Fce Determined bY �S�«g
Sewer Main Cl�azge $ Agreement Necessary [ J Not Necessary (]
•���
STIPiJLATiONS:
s io�-�-'��-
�' `D
.�' I v
�
BUII.DIl�TG PERIYIIT FEE SC�ULE ,_.. _�.,
�-
Thc Chief Building Official shall, before issuiog permits for the erection of any buiiding or saucwie, or for
aay addition w anp existing building or strucarce, or for any aiteration or cepair to any existing building or
mucture, upon appi�ation therefore, require the payment by the applicant for such permit of fees W the amouni
herein beIow set forth and in the manner herein provided to-wit:
$1
�501
TQTAL VALUE FEES
to $500' . S21 (Minimum Fee is $21 plus siirctiuge)
to 52,000 $21 for fust $500 pius $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$2,001 to 525,000
$25,001 to $50,900
550,001 to $100,000
$100,001 to $500,000
$62.25 for first 52,000 plus $12.50 for each additional $I,000
or fraction ttureof, to and 'uxluding $25,000
-$349.73 for first $25,000 ptus $y.W iur each-addidonat $1,000
or fracdon thereof, to and incIuding $50,000
$574.75 for first $50.000 plus $6.25 for each additional
$1,000 or fracdon thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each addidonal
$1,000 or fraction thereof, to and i�luding $SOQ,000 ,
4.
$500,001 to 31,000,000 52887.25 for the first $500,000 plus $4.25 for each addidonal
$1,000 or fraction thereof, to a� including $1,000,000
$1,000,001 and up
$5012.25 for the first $1,000,000 ptus $2.75 for each additional
$1,OU0 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
cco�nu c� su�u o�y�
Altemate "A": Removal and replacement of curb and guttec only - Driveway width plus 6 feet times $13.50.
Alternate "B": Removal and repiacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feec times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from t� time of applicadon to allow for proper
review of the proposed structure a� of t}u construction site.
A Certificate of Survey of the lot, showing the location of the founda6on once it has it has been. constructed
will be required before proceeding with the fiaming.
�- •.:.
. � - � wucti � . � . . P .
c;cy or Fr�ai�y 2 8 0 7 �
�iTMET°°°°T�E'W'Ng BUILDING PERMIT
;, .
. .,
� ��._.��� COMMUNITY.DEVEIOPMENT DIV. /
� � � PppTECTIVE �NSOECTION SEC. /n5��
� ••�
� V
� j �•"1 � CIFY MAIL FRIOLE� SHU NUWER �EV WTE P�GE 0� ��MOVEOlY
�----� • ,,, 612-571-3460 9/0.F15 10I2/48 / /
JOB� AODRESS �651 Arthur Street NE �
1 LEGAL �OT NO. BLOCK � TNACi ON ADDITION SEE ATTACNED
oescA. 13 2 Blomber Estates SHEET
t PROPERTYOWNER MAILADONE83� Z�V PNONE
James Krantz 784-3372
J CONiqACTOR MAIIADDRE35 EIP VXpNE LICENSENO
Seal Guard S stems INc. 91 C n A -
a ARCNITECTOROEStGNER MAILADDRE85 ZIV PNONE UCENSENO.
S ENGINEER MAILADORE38 , Z�F PMONE UCENSENO
B USEOFHWLDING
Residential
� c��ss av woaK
p NEW ❑ AODITION ❑ ALTERATION � REPAIN ❑ MOVE O REMOVE
B DESCRIBE WORK
Rexoof house and ara e 20 S Tear-off
9 CNANGE OF USE FqOM TO
STIPULAT40NS .
Underlayment must comply with the State Building Code.
� � TYpEOFCONST. OCCUP�NCYGROUF OCCUPRNCYIOAD
SEPAPATE PERMITS ARE REOU�REO FOR EIECTRIC�L, PIUMBING. NEATIN6.
VENTI�RTING OR pIH CONDI7IONING.
THIS PERMIT BECOMES NULL RNO VOID If WORK ON CONSTRUCTION 20NING 50. FT CU FT.
AVTHOflIZED IS NOi COMMENCED W�TNIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSVEHOEO OR ABANDONED FOR A PEAIOO O: 120 DAYS AT
ANY TIME AfTEFi YYORK� IS C06kMENCED. NO. DWL,G. UNITS OFFSTREET PAPKING
I.MERfBY Cd$RTIRY�Ti1RT 1 NAYE���AEAD AND E%AMINEO TNIS APP�IC�TION ST�lLS GANAGES
� ANDKMOWTMESAM#�TO�ET�:IiEAN�CORRECT.ALLPROVISIONSOF�AWS yA�U�TION SURTAX �
ANO QRDINANCES 60VERMMG�TH15 TYPE OF WOpK WILL BE COMPLIEO
WITM. WMHTM�fl SPECIiIED MEAE�N OR NOL THE GRAN7ING Of A PERMIT 1] 1 . HE1
DOES�NOT PNESUME TO GIVE �UTMOHITY TD VIOLATE ON CANCEI TMfi pEqMITFEE SA�CIIRRGE
PROVISION$ OF ANY OTMER ST�TE OR LOCA� LRW REGULATING CON•
$TqUCTI�N OR THE PEpFORMANCE OF CONSTRUCTION Fire S 1.7I.
PUN 11 R FE TOTAI F .
2
YGN�tUAEO�CON"PICTOAOAkU1MOA�2ED�GENT �o�rEi pp� Eq�y A7ED IS YOU¢R PEAMiT
� '�V �
S�GN�fUNfO(OWNfP�6pWMEABUROEM� ��ib BLp( 50., pllE
NEW
ADDN
ALTER
��
��
Construction Address:
Legal Description:
`���,�( �` ��s— CX�/�f�'
CITY OF FRIDLEY
6431 University Ave NE, Fridley, MN 55432
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 4/1/2004
(763) 572-3604 Bldg Insp
(763��T1-7287 Fax
I�
Owner Name 8 Address: �umct 4YV�el'1rn! Y.rz�-�jZ— Te�. # 7(0�� )R�1-33�d-�
Contractor.ZurnL�iV1(' (�� � (,��1c�,y MNLICENSE# �D0.3(on�o
Address:�DLI_L l.�bnt.l,C.�I-��(I �,(.L�_C�Yn -�i.lfial. YY�I�54j.�Te�.#�P3-�aZ73Zo
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Widfh Height Sq. Ft.
Length
Length
l�t?i�1
�1�0
Height Sq. Ft
Hgt/Ground Sq. Ft.
Construction Type:1 C��CCCC lA_)I('��I9Du�l�i llp.► Estimated Cost: S ��-,�• U�
r IZJZ.�>�
Driveway 6�b< Cu Wi h Need�ci: _Ft + 6 Ft =_Ft x$ _$
DATE: ol '.�' � APPLICANT: �� 1� h� �n.bt� Tel. �• l7v �_ �
Call (763) 5723604 for Pertnit Fees ff mailing in applicatlon. Fax to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee $��3•� Fee Schedule on Reverse Side
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ ��i .31
$ G.15
$
$ ,�'. o0
$
$
$
s G� l
65°/a of Permit Fee
.001 of-PermitValuation (1/10th%)
$.50/$1,000 Valuation
$1350 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 [ ]
STIPULATIOLJS:
BUII.DING PERNIIT FEE SCHEDULE
The Chief Build' fficial shall, before issuing pernuts for the erection of any building or structure, or for any
addition to any�' building or structure, or for any alteradon or repair to any existing building or
structure, upon appl�,t�therefore, require the payment by the applicant for such pemut of fees to the amount
herein below set forth the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for fust $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each addirional $1,000
or fraction thereof,to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each addiqonal
$1,000 or fraction thereof, w and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fracdon thereof,to and including $1,000,000
$5,608.75 for the fust $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
CURB CUT ESCROW
(Concrete C�u�b Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate
Permits for construction will be issued a m;nim�m of 24 hours from the time of applicarion to aliow for proper
review of the proposed shucture and of the construction site.
VERIFICATION OF FOUNDATION
A Certificate of S7uvey of the lot, showing the locadon of the existing foundation will be required before
proceeding with the framing. New Houses Onlv
Inspections
763-572-3604
763-502-4977 fax
APPLICTATION
WATER AND SEWER
PERMIT APPLICATION
CITY OF FRIDLEY
EFFECTIVE I/1/09 �
YOUR
Permit
Received By:"rr�
�,'. �-h r��lr
�•
THIS APPLICANT IS: ❑ O�-W7NER L�CONTRACTOR
JOBADDRESS: __ /iL'� J ��'�(�v� r� �
NEW CONSTRUCTION PERMITM (ff APPLICABLE): _ .
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STqTE
LlCENSE WITH
ADDRESS:_ %4'J ! ry+ Y?�v/' j f QTY
�.nrv�c:_ r��ln -- �'vvTl
ADDRESS: %�(S y i� c� 7�` ✓%Yi iv C1TY
STATE
CELLPHONE
STATEBOND:
❑ SEWER CONNECTION PERMIT
CJ WATER CONNECTION PERMIT
�/ � ��
WA'I'� SEWER LINE REPAIR
r
❑ ADD STATE SURCHARGE
❑ SAC CHARGE @ $2000 =
$50
$50
$40 �V, ��
$.50 1 S�
�x t,'HAKGES (IF APPLICABLE) PAY TO UTi W TY B]
NEW WATER METER COST— SEE UTILITY BILLING
SPECIAL ASSESSMENTS— SEE FMANCE
WATER TAP — SEE ENGINEERING
INSP OR SHnT_nFF i u���v�,.�.,� ...,,,...,..,,, m...�,.
-I�°�
�
: THIS IS AN APPUCATION FOR A PERMIi-N07 VAUD UNTIL PROCESSED
I hereby apply for a water or sewer (new connection or repair) permit and I acknowledge that the information above is complete and
accurate; that the work will be in c� fo�� with the ordinances and codes of the City of Fridley. I understand this is not a permit but
only an application for a permit an,w t�fq�s�v,i�out a permit.
��
SIGNATURE OF
APPROVED BY:
COPY GIVEN Tb'a
� PRINTNAME: ��'"'P ���jl 3 ,�.3��;}5
DATE:
`"... _ DATE: � u�.�.� �C,�' �,
BILLING (oniy if new meter) ❑ PUBLIC WORKS C ENGINEERING
� City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977