AF - 35711Village of Fridley, Minn.
'� BUII.DIN6 PERMIT
N° 141 p�ce of dNSP�GTO$ OF BUII.DIN(�}$
owaer
ArchitCCt . .. . F`ridley, Mt1ln. `": !i'a F A"'" i..- [r . 1g�
Suilder �'�+"L[ .
� � LOCATION OF BUII�DING
xo � 4A !�' ., 8treet . G.LA,�f wr T�tr$ � Part of Lot
Block Additi0h or Sub-Divlaion
DESCRIPTION OF BUII.DING
Rront� �.. Depth �."t. Height�� 3torfea� Manaer of Construcrion !`/� M'3-.k.9^YS F
To 7� used se �rL.K.rJ+v�.d{e� To be complet � + .�A � Eatimated �Cos � � � � � 1!'
ei] ,�i.�.i.� t . ed_� ... .r . „ .., i
! A � >+ \l .
Permit is hereby granted to_ �• C.. � '� M� . A` . ,,,�y��r' tp .. (�,rt^,-�.•�L!L.("„�.v4. `
.�
,.� ,`� q `�-�fj—
�e b��aB �+r�'^� �d' � _ deacrfbed ia t'Le above statement. Thie permit ie granted
upoa the eapress coadition that the �erson to whom it ia granted, e.nd hte �ageats, employees and � wor3mien, in � all
the work done in, aroimd sad upon said bullding, or any part thereof, ehall conPorm in all reapects to the ordi-
nancea of H'ridley, Mina., regardiag the-conetruction, alteration, msintenance, repair �and moving of bufldinge
with4n� the city 7imita, and tLfs�� permit may be revoked at any time upoa vlolatfoa of any of the proviafone of eaid
ordinancea.. � �,e�E... { N( £���„�7n \
� � �'ti spector of Buildlags.
AGREEMENT AND SWORN STATEA�+ NT \
In consideration of the issue and delivery to me by the Inspector of Buitdings of Fi'itdley of
the above permit, I hereby agree to do the proposed work in accordance with the description
above set forth and according to the grovisions of the ordinances of Fridley, and,being first duly
sworn, I hereby state and say that the facts sta.ted by e and cont 'ned in the above permit are
true as therein stated. �i .ts , sE.� !')
�P"?2. ,P•��€"i'r'''�
Subacribed and sworn to before me at Fridley, Minn�ta, thi �-
daq of. "''�'"?� r� A.D. 19�. •° 5
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HOUSE"HEATING TEST RECORD
�y,� �'�� �h ��
IT APT.._, RL
� _,
��r SUBURB�
11fA?.�, 01YNER: %%7 �`S.SrS�-s . .
DATE MTG. INST. �_ � �
,SOI.D,9Y -/Z � � fi>.Q.¢'' . . ..
El�eerie.f Nwk �r . a INSTALLED BY 4�a-n�i� ,..a � .
TYPE OF HEAT� : GA � p �s Uns$�. �2�urr�t�iaC .� ;� r
MAKE
Med�l
'^-- A—HW---STEAM_SPACEHTR.__WrITHTR,__, �
CsAS DESIGN OTHER
�/ CONYERSION
� � . . MAKE OF BURNER— !J R-/ ��c�r ��
. .. � . Abdd � .
� � . Max. BTU Ratiny—% ��7 00(J � � .
" . � MAKE OF FURNAGE—_Sr r.�/5
Modd —1�f.6 7 i h� 3 4� n
� �,�,r� CONTROLS
THERMOSTAT �r / , �
�Valw�h f �'tm % ... Hw� Pluy _ . L " V�nf Siz� � 1 .- . .
' � KIND OF LIAFE&_ � ���� � •�
��.tr N.�.�.d . , ./ —�'' ._.6.__NOne
Limlt A�eiwe tIAM - . Drah Hood C� v i' �f� h—�� �ulamr. �� �
�.Fan.S�tth�y�3D .Filbrs .��31s�/6�'i2D-SG� ����� � � . .
��Pilot Typ� . Jr�Rti�d � .rtf �himrHy LoeaHon I�n/()id� � � ��_p�aid� __,_,_�_
$ilof Mpin -�i.. ���My ��i}IYCfIOq -V�r'c� �
��
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�.�Pilet TlminQ S �LC � �ok• Bomb. .. Wirinq �7 � � �
:W. CuF OH' Drafe _O o�_nT y.//�4 -ei T�st Taq. . a � .
1 . � Door Pressw�_�_LiyhTiM In�f. q � /n��.c �
�ax� . J• S P�resnt COZ �_ pote T�shd � .
iry1Lf CFH Pwe�nt p 6 _ _
—�-��— y--=L-� ComPuny T�stin9 . r""0�'" � rt. �-1 r c...f pc
Stack T�np. —�_ P�ranr CO yt Bh �e.. -z
Nam� of T•sHr �- -- U
�om I35 . � . � . . _ .
_ , a . . :.
. �.
" - =� sue�¢cr �� PER �
� c�ty �� F��at�� /� `/� _(,,'(��AA�(�/{F}�/� _ � es5 � ,
AT THf TQP O'f THE'iWIN6 , KU�9�{f �F \ V -1� 'LI\�M (�T
. i� n . . �. �J . .
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. � � y ������ COMMUNITY pEV�60PMENT DIV. � - - � � . .
�_ �:� PRQTECTWEINSPECTION SEC.��� . �
,k�L '�' � , . ' � � � � �
"� '��` M" � CI1Y NALL ` FRIDLE� 550�2 � NUMBER . REY O�TE. G�GE OF APPNOYED BY
� ��,� � '�`.� �I2-57t-3a6o aio-F�s 9/16/86 / / �
. �oe noo s ". 8-:�i't4�4�! . '`�.�„E.
,. 1 C.�GAL:.. lOT .� BLOGK , �RA6T OR ADDITION � � , . . .. . •"r � �. � ' {SHEA74ACNED - �. . .
, • ``:,. DPSISR. 1��.�-rJ.'G � ', .�.Z� Fi].G�L Pdi�SS.- ' . SHEET � .
� 4 qQ,BEpTY�QWNEq. �� MAII ADDIYESS � . - . . .� �.. ZIC. . PMONE . � .
5 'e Hie7.atwski same, 571-897fl
� 3' �� t � TON . � . � � �.Mkltk�PPRE8S ` � � . . i1P. � . PNOME WCENSENO. .. �
. �^,.... : `�� . . . . . � - � . . � . : � � .. . . � � .
<-�
-� a ApGp1TECTURDE$16Nfifl �- MAILR DRESS��� � � :'� LP � � PMONE� � �, UCENSENO
- �` 5 �.� ER � - - � IfiAILADD11E5S � � 21P PHONE � UCENSENO. .
� j :' . . .. . . . . � . . . ..
, : 8����USEORBt1q.01NG .. . . . , . . . .. . .
v CE.�SS:oF-wonK � NEW ❑ -:AbDIT10N .. ❑ ALTEiiAT�QN p., REpA1R � ❑ MOV€ ��O REM01!E � � � �
r.. �'. 8 Q��NIBE24' NX � � . �� ;-� � . , � . �..
� � � � . . . . . �.
y
: 9.i CMAN6E OF U8E FpOM . � . -TO � � � � � . � II
;�..? STI�LATtONS � � . . � . . . .. . . � . .. .
: ,.. , � .. . . .. . ,... . . . .
; ��
.. - � S�,PARA'RE�PERMQSAqEREOUIRE��FOAELE�FTRICAC;P4LM&N6;HEATINO, �PEQP.QQNST. OCCUPANGVQRbUP��-� OCCUPANCYLOAD
YEMt1LLAT�NG OP �IR CONIXTIONJNO: � '
TFf1� �£RMIT �BEGOMES NULL ANO�:YCHR;��F WORIQ OR COHSTRUCTION Z�� gO�,fT. CU. FT
qltT,M 1$`NOT CAMMENG�C4 WFTF� QQ.OM�k$, Oq 1F CON$TRUCTIpN : '�' `,�i , . .. � �
OR 19ftl� SU3PfiyDED OR Ii9A N@bP�iif.ik�PFA100 OF ��420 OAY8 AT � � �� � .
�� AMNFpbI� AfTEf€WORK IS �OM�A��EO. � µp . OFFS �REET PARKING
� t N@REBY: CEATIFY TMAT I HAVE.REkO AND E%RMINEO THIS APPLICATION STALLS � GARAGES �
" ANIIKMQVY"tME$/.tAETOBETRUFAHUCORR�CT.ALLPROVISiONSOFlA1N5� YALUA7 � � - � SUR AX� . �
� AND OF�NAf�ES�OYEPNIMG THIS TYPB-OF�WORN��WiLL 8E COMPLIED' - � �
�: WIiMW FHEf9$V(fCIF1HDMEREINOR�NOT.THEGRANtINGQiqPERMIT� ��-�I�OaOO � �� � �rSO� �
� AOES'NOY`PqEBLLME�TO�GNE AUTHORITV�TQ YIOLATE OR CANCEL TME�p�pMIT�PEE � � SACGNARGE � �. �
� PROVISION$,OF ANY OTMER STATE OR LOCAL`�LAW REGULATING GON- �,�'y � � :
. STHUCTION OR THE PERPORMANCE OF CONSTRUCTION. �Sl�I�y�y' <%" � ... i
. . � . . . . - � . . . . L �N N � - E ; TOTAL F�� .
i. . . . � ._ .. p .
. .., .. ,,..� , yfi1�r0V �
� UAEOF ON AnCtOPPa � ORI NGENI � IOATEI � yy�EN R[ TED T IS VOyq,P p11T �
M� � f.
b_ Y �
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Si � U Of OWNEfi�Ji 0 NEA BNIIfERi � . ipAiE� . BIOG N G pPiE ...
-----�
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ADDN. [ ]
AI,7ER. [ )
Construction Addresa
Legal :peaariytior�; i ui
Ovner fl�ae.i 7�dress: ,�
City of Fridley
R-1 AMD A-2
Building Permit Rpplioation
�
Effecttve �tlt/8c
�-�,r „r��oe,� �Z
Tel. t ��" �
�_Tel. � ��'° o
ir.aa:.�L��-°---,�5.��� f�V� �.2/DLE�/
Attach ta this,application, a Certifieate �' Suiwey of the
3ot, Wi�h the Dropooed eonstruction Qraan-aa it to scale.
DESCRIPTION OF IMPROYEM&�R':
e�� , �IYIliG AREA LengEh liidth Height Sq. Ft. /�
TF�'E AAEAc Length _�� Niath � Height � Sq. Ft. ��C/
DECK AREA: Length Width Hgt/Grnund _ Sq. Ft.
OTHEW:
0
Corner Lot j) Inside Lot [� Ft. Yd. Setback Side Yard Setback�
Type of`Coqstruction: ���� Estimated Cost: S �
Approx:. Completion Date: /� � � ��
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: S E
See Back Page for Explanation
DI,TE: �'����� APPLICA�T:,,��-���� Tel. ♦ ������ 70
Perc.it Fee
P1anrGheck
SGate Surcharge
SAC Charge
Park Fee
Sever Hain Gharge
TFI�I�
STIPULRTIORS:
CITY OSE ONLY
y %� _`5 d Fee Schedule o�s Aeverse Side
� 25i of 8uilding Permit Fee
y . 5 U i.5oiti,000 valnation
� 5475 Per SAC Unit
� Fee Determined by Engineering
#
� n!, Jlgreement lteceaasry [] Not Necessary []
� r UV �
=.,. �
BDIi,DING PBRHIT P'EE SCAEDQLE
The Chief Huilding Official ahl11, before iasaing permita for the erection of any
Duilding or structure, or for any addition to any existing Duilding or atructure, or
for any alteration or repair Lo any eziating building or atructure, upon applicatlon
theref.ore, require the payment Dy Lhe applieant for such permit of fees to the amount
herein-below set forth and in Lhe manner herein provided Lo-xit: '
Totnl Yaluation
=1.00 to i500.00
t501.00 to 52,000.00
sz,00i.00 co 525,000.00
525,001.00 to ;SO,OOO.OD
550,001.00 to S70D,000.00
1100,001.00 end up
feea
>:=.�.#to.t►6� �tl�lintmns Fe+�` ��a 3t�5:�b) ���
510.00 for
additional
E2.000.
the firat E500 plus E1.50 for each
E100 or fraction thereof, to and including
E32•50 for the firat E2,000 plus �6.00 for each
eddiLional E1,000 or fraction thereof, to and
Yncluding �25,000.
E170.50 for the first E25,000"plus aL.50 for each
additional E1,000 or fraction tdereof, to and
including E50,000.
�283.OD for the first E50,OD0 plus E3•00 for each
additionel I1,000 or fraetion thereof, to and
lncluding a100,000.
E�33•00 for the firnt E700,000 plus �2.50 for each
eddational tt,OpO ar fractiom thereof.
DRI9EMAY DEPRESSION ESCROif
(Coricrete CurD Streets On1y3
Alternate "�": Aemovsl and replacement of curb and'gutter only - Driveway Width plus
6 feet time. E13.50
Alternate "E": Re�ovzl and replacemer.t of curb and gutter and'in�tall a 3 foot wide
approach with 6 inch derth - DMveway width plus 6 feet times E15.75
VERZFICATION OF FOONDATION
Pereits for construction will be'3asued a mir.imum o" 2�t hours fros the time of
aFPlication to allox for praper revYeu of ihe propo�ed structure and of the
construction site.
A Certificate of Survey of the lot, s5ouing the location of the foundation once it
�as Oeen constructed v111 be requfred before proceeding vith Lhe framing.
��, „_g
�
�
CERTIFICATE �OF' �5'URVEY
KURTH SURVEYINti. IWC.
� . JOD2 JEFFFRiON ST. N.E. -� �
COLUWIAllil6MfE i612t -
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W. M AO�ORT �11{ NISRAIiY �PY Y[ 00 �Npl� MY W�CT NMqVqqN
� YMCO� t1� I.A� 0/ ?I� �TA7t O► YMMdOTA. '' . .
OATE _MAY 6 , 118V
��_ SCALE 1'� :_' �p`
NO..� �Lll3 0� �RON MONUMENT
�b� ��� . � 30 . �
��$ ._ . � ��" �� •�' ,. � _ •
���Rllfii.f i I •
�y� .
.
o � ' � $L, .�. �, .
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t.:.OTS �1 , 5 AND. �o
BLOC1� 12., �'OC,,ETHER W 1TH
1�tAL� OF VACATED 1�LL.E`f
. A��tO�K� C�U�TY► �-i'�111NE5'Csi'A —
s� ._: ..
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,
�, � 5��+
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c�ty o� F�����
� �. . !�T THE TQP OF TNE TWfNS
�. ..
� � � � � COMMUNITY DEVELOR���kNTDIV.
. ��""'"� PPOTEGTIYE INSPECTIQj}'SEC.
r=
. . ( ��� " ' ` � � CITY HALL FRID4EV �. - 55432 � i
�' •� 612-57A-3460
aA�X°���'' 6468 Ashton Avenue N.E.
� {,Q pQ� - � � BLOCK � �. TRACT O
. � �...
SUBJECT � . � �
BU�L�fiIU� PERMIT
YUMBEF � REV O}TE PAGE OG
910-F15 : � ��� . . ,$/23/89 � �
_ ZDIiY �
33100�
.� 1 ifiGAL. . r . RADDITION . � � BEEATTACMED>. .
� pESOR} 4; 5, 6", 12 Fridley Park sHeer -
' OiMNEfl,< � �. MAiLADORES§ . � � - � .. ... p . : . .
; Ste�hanie Bielawski 6468 Ashton Avenue N.E, 571-8970
� � ` &. CONT � TOR� . . . MAlIADDR@SS � , . � �ZIP ' � . PMONE . UCENSE NO. � �
$dDRe � . � . �. . . ,
� �1� ARCN176CTORDESI6NEB RU14��-D6RE&S � .. � " �T�P � PMONE ���� UCEN3EN0. �
�' . ��, � S �� EN6INQER '�� �� � �� � - MAIL ADDRESB . � � -- � ' - � ZtP � PNONE LICENSE NO.
.. . 8' USEQ$BUILDINO .. . � . . . . . . �� �
7 CLA68iOF WORK . .. . � . ... . � �� � .
� NEW ❑ ADDITtON ❑ AITERATION � ❑, flEPAIR ❑ � MOVE ❑ REMOYE � �
� � - B CE8!'�i18E.YtORK � : . . . . . . . . ..
Cqnststtet a 38.' x 26' Detached Garage .�nd�; coAipleti.on o£ the conversion of
;�
tike exiS't$ng attached garage tq livi:pg aY�ea.
� > �,
:. 9 S+UNGEO -USE�:H. .. � . - . . TO . . . . , . . �. �
. � - , ' .: - 'S
' � ' - . . . . 'A
STIPU �;TIONS ��. . . . ... . . � � � - � .. .� ...'rp
. '�-. , � �:�>' �
> Zhe<attached garage coz�version to living arear��;north wa11 must be a '
fire.ra� wall with-no openings. Approv�d by Pippeals Commission May, 1986:.`
r,
;3-
- SEO�RRTEPERM176AREREOUIREDFOR ELECTRICAE.VLUMBING,HEATING, TYPEOF.pONST. OCCUPANCYORpUP OCCUPANCYLOA� ... �
' VEN11tATING OP AIR CONDITIONING. � - � � � . � ' - �.. � . .
� � TNIS;pEFiM1T`BECOM6SNULL ANQ VOID If WORK-OP O§1NSTPUCTION= 24N�N1G:. ' SQ.FL � CU.!FL � '
� AUTMORIZED IS NO'fi�COMM@MCEA WITHIN� BU �AVS, OR IF CONSTRUCT161lf' � � � .
t!
� OP WppK11S� SUSPENOEDOR ABANDONED iOR A.PERIOD OF 1T0 DAYS AT-� � � �
ANV jIMEYAiTER WOFN IS COMMEMCED: . � Wp,;:pyy�p, . OFFSTREET PARKING . ��.
. 1 NF„1!E$Y.�',ERTIFY THAT I HAVE F.EAO AHD�EXAMINED THIS APPLICATION �- �� STALLS GARAGES �
t+ ." AMD.itN(N/�,!;�i£6AAtETOBETF�^ANDCOpRECT.ALLPROYISIONSOFLAWS VALUATION�+ , URTAM � �
,"� AfiO,OAWFt�XIC.�$.��$OVENNWG.THI$�TVPEOF WORK WILL BE COMPLIED $14f.444 � � � . � � $'�.23� .
WITN WNF,A'#I�R.SPELSIFIED MEREW'OR NOT. TNEORANTING OF A PERMIT � � " �
DOES NOT��.GftE&k/N6 70 GIVE AU7HORITV i0 410LA7E OR CANCEL THE pEqMITFEfi �' � ��SACCHAp E;- '
PROYkS{qN5 OF .RMY�OIHER ¢TATE-OR LOCAL LAW REGULATING CON- `', �`j
= SL[�,4T16At 4fi TY#§ P�FS?AMf'ANCP.Of CQd$Tl�1UCTION . ���� � ' .�
. ra'�: z�,�
v. e_ A3a4is�'mf. , �'� . -=s . � .. � .. _ . . ':` �-iNA EE€" yt.. . _ '�u,....'a.
�. . .._�r ., ,.. . � .-. . .. . ,
�
� ��
AI7II�I [ j
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•% � y -
i�l AND F�2
w,t�a; �, p�mit t�pplicaticn
ns�
Effective 5/1/88
L�1 ne�3ptian: �T5 `� � � � ,�/ c.�' /� w/ / .s� ✓a�ec� af/°� ,2� � E �
owner xa�e & �r�s: 5���1/3NlE ,�/EL.�GcJosX/ �. #.S7/-�}'�7D
��: Sx� rn e �. �
�:
� . . ,,.
�. . . �, . .,N.
�,:.«; �,,,,,
I OTi�[t:
Attach to this applicatiwi, a Certificate of S�uvey of the
lot, with the prcposed oa�structim drawn � it to scale.
ffi�CRIPFI�1 OF II�lmV89�iP
Iength Width i�ei.ght Sq. F't.
Ienqth � Width d� � Height �_ Sq. Ft. �
�e�h WidtY1 Hgt/GY'awri _ Sq. F't.
Oaz•ner Lot [] Inside Iot � Ft. Yd SetbacJc Side Yazd Setbacks
`Type, of oor�ttvckicri• LvmBfi� .�ri,�*� oost: S
A�x�. a�letion nate• .va✓ 1�f I9�9 � . ��yy .
Fropcseci Drivaray Width If Nea Openi� Is Desired: r^t. S $
Width + 6' See BacJc Page
�. ��. ��: �. .��ew� - �. # 5�� �9�a
Ppxmit Fee $ ���, O D
State Surd�ax'�e $ '�%�
� � $
DrivewaY Fscrvw S
Fark Fea $
Sawer Main cl�att�a $
.v �
--- � -. _ —
� S'1'IPOlATICAIS:
«�+� ��-,- .: �
Fee sc3�edule an Revetse Side
$.50/$1,000 Valuatian
$575 per SAC Unit
Alt. °A" ar Alt. °B" Above
Fee T]E��„n;,�,� 171' �9��3
�''�t �Y [ ] � �Y [ ]
.
%/ \/^����.9'� `/
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I
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The Qiief Building Official shall, before issuinq petiaiits for the erection of any
�+,; � airy or sttiucGure, or far any aaaitim to am existing builaing or struchue, or -
for any alteratian ar xeQnir to ar�y existins building or stn�cture, upon ap�licati� .
therefore, z+equire the payment by the applicant far au3i petmit of fees to the amount
herein below set forth and fn the meru�ex het+ein prvvided to-wit:
RV�L VAIIJE
$1 to $500
$501 to $2,000
$2,001 tA $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
�a.
$15 (Mini�ona Fee is $15 plus Q,+�,�+,�)
$15 for fitst $500 plvs $2 far each additi�al $l00 or
fzactinn thet+eof, to and includi�xJ $2,000
$45 for fixst 52.000 plus $9 far each additional S1,000
or PLBCtfah thereof, to �rfd includirg $25,000
$252 far first $25,000 plus $6.50 for each additi�al $1,000
ar fr8cti.an 'thereof, to atd includit�g $50, 000
$414.50 far'first $50,000 plus $4.50 far each additi�al
$1,000 a�' fractior► ti►eteof, to ard including $100,000
$639.50 far fiist $100,000 plus $3.50 for �ch additi��al
$1,000 or fracti� t1les+eof, to and includinq $500,000
$500,001 to $1,000,000 $2039.50 far the first $500,000 plus $3 for each a�itional
$1, OQO ar' ftactiaa� thet+eof, tA arri incltxliry $1, 000, 000
$1,000,001 ar�d up $3539.50 far tl� first $1,�,000 plus $2 for each additional
$1,000 ar $action thereof
�tIVB�Y D�i ffiCRIOW
{Ooricsete Qui� S'ttieets On1Y)
Alternate "A": Remvval and xeplaoement of aixi� ard gutter a�nly - DriveFray width plus
6 feet times $13.50.
Alternate °g��: Ranoval ard r�l.aoanent of wffi atrl gutter anl install a 3 foat wide
apQZOac3i with 6 fl'x3i degth - Lk'ivewdy Width plus 6 feet times $15.75.
VERB�IC�1TIOt�T OF PO�TIdIQ
AeYmits for o�ctian will be issued a minfm� of 24 hwts f� the time of
appliwtim to allow far p2vper x+eview of the p�c�Cl stnx.ture affi of the
�ion site.
A Oertificate of Sluvey of t2� lot, shawing the loc�atioai of the faux7atio� onoe it has
it has been �tructed will be x+equix+ed before pxnoeedirg with the framing.
.
,
�OOZJEFFERSON ST.N.E .
� COLUMBU MEIGMTS 55471 •
� wsw�v �wn�r rwr n��� wwv�r.
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MtNNE50TA REC-a
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DATE .L'��Y 8 . \98V
� SCALE 1'= ' a4�
p �'RATION NO. i IG.►13 � � IRON MONUMENT
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FRIDL.E`( pARI�,
ANO1�A` COU►.�TY, .j�UµNE'S�t'�TA _
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�CURTH SURVEYING, lNC.
+1007 JEFFERSON ST. N.E.
�1UM81A MEIGHTS 65l21 - �
t Nuwr pwrm nur rMa wnevsr.
�IC lf111T 1 AM A qILY II�iN'I�p y1
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IYtYOR YNOO1 1Mt N�W� OI TIIt �TATi O► MN'MIpOrA. �' .
DATE �'�►AY 8 . \98V�
SCALE 1'� �� �p'
I�TFtATION NO.� K113 o=iRON MONUMENT .
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I�1 ADID I�2
HI1i1diTlq Pezmit AppTfcant3X7[►
Effective 5/1/88
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PURCHASE ORDER °ATE
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THIS
� F 11524
� THIS NUMBE(i MVST APPEAR
ON ALL CORRESPONDENCE
SENT TO U$
51,000•00 ONLY
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su� ��i ,�'-IAN� � ,C�/�LRGt�S�!
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+ �. K,w,;� �� �.��tl /�.//lrtl 4�JFJY�;vZ T
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812-571-3150 �� WNTACT... -.._.. ....
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; PAYMENT VOUCHER
��BY SliiiJINGTHIS DOCUMENT BELOW I HEREDO AUTHORIZE
PAYMENT AND THAT THE GOOUS AND SERVICES HAVE BEEN
RECEIVEU OR RENDERED AND ALL CITY GUIDELINES HAVE
..�!_ FOLLOWED IN THE PROCUl�MENT OF THE BELOW
5`TATED IiEMS. � �
TOTAL
� ANU V1�FItM A[3EN(:IES WITN WMOM IT PURGMASE5 PRODUCTS OR SEqViCE$ TO DO LIKEWISE.
EX�AIPT FiKHA SALES TAX AS A POLITICAL SUBDIV180N OF TNE 8TATE OF MINl�SiDTA CITY OF FRIDLEY NO. 8030901
NMITE. VENDOR — VELL�l, PURCHASINCa —� AINK, ACt;OUNTIN6 — Oq.DEN ROD, DEPT. HD.
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7l�e Chief Building Officia2 shall, before issui�g peYmits far t2�e erecti� of any
buildi.rg or sstmct�u^e, ar for at�p additioai to any e�dsting buildi.ng or stzuctuYe, or
fc� azry alteration or iepair to any existiuxj building ar structure, upon applicatiari
thPrefore, require the gayment by the applicant for ax3i permit of fces to the amau�t
herein belaa set forth amd in t2ie marner herein �wided to-wit:
TC71'AL VATi7F.
S1 to S500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
�a
$15 (Minimmm F1ee is $15 plus �,,•.r,mr�)
$15 !or fizst $50o plus $2 for earh �ditioa�al $100 or
fraCtim tYye2eof, to an3 includir�q $2, 000
$45 for first $2,000 plus $9 for �ch additio�al $1,000
or' fLackian thereof, to ard inCludiz�g $25,000
$252 far first $25,000 plus $6.50 for each additional $1,000
or fzBGtian thereof, to and including $50,000
$414.50 far fixst $50,000 plus $4.50 for each additiomal
$1,0� or fractian t2�erflof, to and including $100,000
$639.50 far first $100,000 plus $3.50 for �ch ac�i.tio��al
$1,000 Dr fiaction thexeof, to and includirg $500,000
$500,001 to 51,000,000 $2039.50 far the fisst $500,000 plus $3 for each additional
$1,000 ar' fracti� thes+eof, to and inCluding $1,000,000
$1,000,001 and up $3539.50 far the fisst $1,000,000 plus $2 for each additim�al
$1, 000 or fracti� thereof
11tIVE�Y �RI�88ICN BB�OW
(Oorrcreete c1u�b Stx+eets A�lY)
Alternate °A" : Raroval and replaceoent of curb ard gutter �ly - Drive�,*ay width plus
6 feet tim� $13.50.
Alternate "g": R�mval and replao�en't of c�rb and gutter affi install a 3 foot wide
approach with 6 indi deptli - i�riveway width plus 6 feet times $15.75.
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Permits for oar�truction will be iss�iad a mini� of 24 houts fma the time of
applicatia� to allow for pxaper review of the praposed stnicture and of the
oonstn�ct.ioai site. '
A Certificate of Siuvey of the lot, showing the location of t2ie faudatim once it has
it has been oonstxucted will �e x+equired before pz�ooeetiirg with the framvig.
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