AF - 35309�
�
City of Fridley
4T z� roP a� T� �w�Ms
,
�'x.-'-'^^� GOMMUNITY OEVELO/AIeNT Q1Y.
�t � MOT�CTIVR Nf�CTION ONT.
i .--•� � C�Tr �1µ.� s�u04RY �Mi
f�..� .� N�-b�0�s�0
Job Address
_ �� � �
ner
P
Contractor
Kind of Bui ding a
�
Comp etion Date
_I���!�I
d
�
� --
`I`I� f i .
; n
�fl�
•,��Ivro
•x�d
.�g,�1
i
i�saa�l
�•MNiva
m
y� 9NISV6
� % H�1V7
'O o eNrvaol �
:3 � aoo��
� T—
�O v I saaMONsI �
O� �a
�q •tNno�1
d HNiaol
b
A � BA�i11I
HsrM �
sliN�s I
fN16YY
�ve
e-rr►��an
o�
��
�
�
i
li
I
�
.° �
.�
�
� I
I I i+�
I �
I �
If�I
� - �
I
� � � �• �
.�
� � � � �
•r
/°%S�- �5
�
. , � �� i
=I��EGT
�
PLUMB I�r, PERf1I T APPLI CAT I��d
�t �v. p�T[ �a4E 01� � Ov D 9r
- 0 2 1 7 1 1 $00
S P one
S /) P one
A A
se
�r,bLimaLea �ost —
Plumbing Fixture Rates: N0. R�,TE TOTAL
Number Fixtures � x $2 ;00 ,Qa
Future Fixtures _� X $1.50 �:��j
New Fixture-Old Open. x $1.50
Catch B�.afn x $3.25
---___
Water Heater-99, 000 BT[J �_ X$3 . 00 �, (� d
Ground Run Old Bldg. x$3.25
Elec. Water Heater �— —�
X $2.00
Gas Fitting Fegs:
lst 3 Fixtures �_ X $2,00 �.��
Additional Fax tures �_ X $ .75
Gas Ra,nge-199,p00 BTU x $5.00
Repeirs � Alterations
See
Deacription: Code
State Surchart�e
.50
TOTAZ FEE $ �_( .�p
he under�igned hereby makea application for a permit
or �he work herein apecified� agreeing to do all work .
�n atrict acco�da,nce with the City Ordinances and ruling
f the Department of �ui9.dinge, and hereby declare that
11'the facte a d reprea ations atated in this
p�.lic��ion a�true an�r�ect.
�� �
Iate
� � �
o !g! �
� b
� �t� �
f� � �
c4 � � ��qa
p� ry.� yV�;�yp
W- A � Rd
r�",� .,t
Y
� � � �
� �
�
� �
�
M �
� a � � '
C ca � �
� o M �
� � ✓ � n1 �
� � X
� r. ,. d
S� � � � � �
� _ � �3
�� ��
� �
'� ..,
�
�� �
f't A
� �
� � � °
� I
� �
� � � I I �
�'
� J � p � � �
� � �
$ � � �
� ����
i
� H
Q I I 4+.
� r
� � o �
� � � ti
� �
�
� � � �
�
I � I
� a I
� I
� �
i � �i
�� �
� �
� �]
� �
� �
�� � �
� � �
,
6
�
� �
0
r
�
b
�
a;
°< �
� I
�r s
w
� w
:: �
�.�
� ~
O 7
C 0
-t �
T p
°�
A
A
�
a.
�
� �
�. N
� �
� �
7
� �
�
�
�
�
�� C
� �
O �
w �
� �
ro
� �
� ��
A
�
0
,v 1.
� �i
�
�����
� � �►4
y � � �
� � � n ti
a a. n � �C
tWJ pN 7� r9 �
O J �.i-•,, ;,_, �
a A �° fc° �,
�° � r �' r�
y �
M C*; 9 y �
d�, , e�
.'7� .'i.' O �
x �p � �'
� � A �
~ �1 p O
� � � p
� �
y � �
d b
� �
o �
.. �
� �
�
(A
��no
���s
� ti1 bf U
i
�
I a 3
E �
m n
E. �
� �
��
'��.
z
i
i
I
v
a
�
�
�
�
�
�
�
I
0
�
�� � � �
� �� �
� � � [ � �
� � � � �
� -�t 'O R, �' �
m � a. �
�- �
�����
����
� ti�+ � �.
N O `� �"
� N 4
� � �Q
� � ' v
� : �
: �
�
W���:o
�����
4A $�i 6;J t-.1 �v1
�� �
a �
� � �
`� �e
I J �
c
�
� a
�
� � �
�
.e
r �'•
�
�
�
�, v � � �+
` "/ � �
R� R� � � �
y � N N �
� � o `°
m � �O �' �'
� � � � �
u �
' C �
� q 6i'
G1 O
ai9. �,
r
U p
0Q S
G
r� �
� � � � �
49
�
�
(y y N
� � �, n
aa� �
���.� o
� : r 7 W
't � Cl. �9
� � � G �
� ,�,, -ti a, �
a ,..^ M �
G 9 j •..-
� d� �
��ci?
..d�." a�
� o �
�. � �
m
�. � y�
:�.
�-cy�
N'w ry Ca
�. x�
a� Gi ro
�[�'� .
d
G:p.yt7
n �' �
� 47 �. �...
G���
�� �
O
�a��
�s�„o
� .,
� `� � �
�'�'£��
a��:.
���
, �p
p �
.�i .�e f�
� � �
� �
p �
�
�ii y
� �
� � �
�'.
F"`
ry�
�
�
�
�1
sz.
�
�
�
�
�
�
�
°•�
�
�
�
4�
�tl
�� ��� �,
��
��
�' �
..-.,, �
B_3
ar:y
�� ��
R
�:�° �J
� ��
a�
� �
�,� �&
�.
6� �
asi �
�� s�
��
� '�� a
� ��
��
� s.3�
� �
�
�•
�
�.�
��
e •�
C`�
�,�
�
�
E
� � �
F �
��
�
1
�
�
�
�
�
�
�
�
v3
�
f
;
r.
Y ,
, �
�.
; �� _
, .
� & �
, � ;
,, � : �:
_Y g{ ,'�
!i.
�
Y ^�j �C
r- ?�,
: t:
.�
?�
� �
� �
� a � � �
� � w � �
� � �� �
� d, x
� � � � � b'
� � � �
� • ��
�`�
�
!
� �
cr
�
� � I '
�
� �
� �
� �
�
� �
� � � � �
N
� � � � �
i�°
09 M !A 'i7
I
� O
� O I �
�
�
�
�
�
�
�
O
�
�
�
�
� o a
� � �
O �
� � I
� � i
�o � I
s � �
� �
� �
�
�\
"v
�
�N �
n � �
o �
�
�
c�
�
�
Mn
1
O
r
�
a
�
�
� �
w S
� w
.�.. �
� Y
�, '�
? ~
O x
�o
� �
A M
A
A
�
�
� �
A
� z
n
�9 ry
��
�
�
�
O
�
�
�
0
C o
W
�
N
�
�����
�,
� � A �
a a `D � �
� � �
oN � '7° -�
,� $s�s���,q
� � � r �j
� � �0
� � 1 � �
�s � o S �
° � � g �
� � � A
�
� �
r
i�i ,�
d b
�o �
o �
.. �
_�
M
t�
wg ;a O op
O � � O
b 'iA fA U
i .
O. �
z m
� �
�, n
�' �
�° ,
�
� I
O
ig
9
0
�
�
(�
O
�
�
�.
S/
8'
�
��� �
� � � �
� �
�° Q° �
>a.���
� m $�a��
g o �y �
r � � �
� � � �
W a
7 s � �
� �
M p �
� S � �
g � �
�
pW OOf OpI 4: Op
Ci O O � O
M !3
1
� � �
� � y
+4 ro
�
� a
5
�
�
�
�
�
,�ba��w �. m
� r "� �
� �
� a � � �
=; ' -°s �
� � � �
� � � .
u � •
' c `� �
g � �m s
d �
� °
,o° $ .
$ �
. • � �
Wp qW Of Q
C P � � �
�
�
��� A
aa� �
� � ti � b
��a�.�'nff4w�
�
���"� 3
d �q
�7;?.W�e
�y �,�ya1 °'w9
���.
�� o
Nr D.�
O .,
07
'J � '� `l
y M'0'( Q�
� � � �
b G• � � .
Cay'p
� � '�
�y�n
o- ..sr
�
�
��9�y�
�A„O
�1
�� A �
a.
a ���
����
���
5 0
� �
w �
���
�.
t�
;.v
'ii
�.:
�
�
�
�
�
�
:a;�
_Y�;
':�,
�Y
b.�
;""
�z � y.
a•.:
s� �..
�.
i
�
�"" .;�
��
�
�
:�
:tiF
r�
i�
� \
. �,
`�
SUBJECT PER �����
c�ty of Fridley
' ` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T REC .
r
COMMUNITY DEVELOPMENT DIV.
' � ti: — ����� ��
r � � PROTECTIVE INSPECTION SEC.
1 = �
�4 /"�'L � CITY HALL FRID�EV 55432 NUMBER REV. DATE PAGE OF APPROVED BV
"°'� � ,�� 612-560-3450
910-F15 10 30 74 � �
JOB ADDRESS 6266 Ben More Drive
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. L,� & 48 1 Heather �111.5 SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
5outh Towne Realty 151 5ilver Lake Roa3
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS 21P PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 48' x 26' Dwelling and a 22' x 22' C�.rage
9 CHANGE OF USE FROM TO
STIPULATIONS Provide a hard surface dxiveti,ra.y. Provide a verifying survey before
capping. Locate house caxefully to meet 10' x 5' side yard setbackso
SEWER LOCATION: 3�' S.W. of Manhole (Invo 919,12)
W;ye Elev: 919.28
Top of Footingz 922.28 Min,i�aum
!n'�fTER LOCATION: 11.5' S.W.of Sewer Service
S�PERA�`E PERMIT� REQ,�aRED �'(3R �►11RlNG,
�-i�AT{1�aG, PLUMBING AJ�D �;GNS.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOCZ F11ICl•G'
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R�. 1.240 24, 960
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 COHRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �Y28►69� �.4.35
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMiT FEE SAC CHARGE
PROVISIONS O Y OTHER ST E R L CAL LAW REGULATING CON-
STRUCTION T PERFOR O ONSTRUCTION. � �`SGoOO �S`300.00
� � PLAN GHECK FEE TOTAL FEE
�-r � ' � $370.35
SiGNA7 aE CONTRACTOROR u H I DaGENT ATEt WHEN PROPERLY VAUDATE THIS IS-YOUR PERMIT"
SIGNATURE OF OWNER IIF OWNER BUILDEflI (DATEI BLDG INSP , pA E�I�' �
�
AP.PLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CI.TY OF FRIDLEY, MINNESOTA
'�OWNER' S 1VAME • BUILDER:�p - j �
��
ADDRESS• ApDRESS: / � r�
� �d��y�n �-��9
� , , ��
( �, � � � sz�T: r��� / 7r��� . �,�?-� J�
NO:.� ^�_�T �
� .
�� LOT:�� �'}_I� BLOCK: �� ADDITION: ��zA�� �� �t��S �
J
i( CORNER ZOT : INS IDE I.OT :
�,
r
SETBACK: SIDEYARD:
Applicant attach to this form Ztao Certificates of Sunrev of Lot and proposed
building loca.tion drawn on these Certificates.
HESCRIPTION OF BUILDING
To Be Used As:
� � " Frant:�;'� ,�<; Depth • � �� Height • :� `
Square Feei:,� ���'� � Cubic�Feet: � � � �
,�'� ' J Front : � Dg�,th :_,;��; � Height : � �
� � � � � ; �� � � �
Square Feet; � Cubic Feet: �` �
TSrpe of Construction: �� �+ �-� -i� Estimated Cost: $ � � ��i `� �� �"��
To Be Completed: - % � � R r �° ,' �l
. "'� ; � �°''�,� r< � �� U
� i
� � "
� �
t , � . �;� , � ;
�,' � .` " � ; p
� � �-, n = f� �, ,
The undersigned hexeby makes applicativn for a permit for the work herein � �
specified, ag�eeing to do all work i.n stxi.ct accordance with the City of
Fridley Ordinances and rulings of the Department of Buildin.gs, a�d hereby
declares that all the facts and representatians stated in this application
axe true and correct. ;/� 7
DATE: SIGNATURE
� (See Reverse Side�For Additional Information.)
�� b�
� �s�.,.=x �, �j, . f �:; ;:�- „
�•
� � � d, e —
a ° ._ _
' '' ,%
t: � ,
� ,mf� � �� � _ °� � Fi
_ - �- �,�„
� �� '
� �
'.� -��.�
i
�r
_. P
�
, � �;
� • � — '����, �.
— �
� '
. � �{ � �
. �y i � `�`�� � "� t �`�j r �: � ��
�...�
i;
Y �
A,
BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing pertnits for the
erection of any building or structure, or for any addition to any existing
building or structure, or for any alteration or repairs to an� existing
building or structure, upon application therefore, require the payment by the
applicant for such permit of f�es to the amount herein below set forth and i.n
the manner herein provided to-wit:
tTNIFORM BUILDING CODE: Z`ype 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. �pe 3& 5-$1.85 £or
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of camputing fees for building permi.ts, the cubical contents
of any building or addition, is cletermined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
ox the cellar to the average heights of the upper surface or �o the average4
�height of the roof su.rface of the main gable of a pitched roof.
For repairs or alteraticns to ax�. existing structure, the fee shall be at the
rate of $3.Q0 per each five huadred dollars ($500.00) or fraction thereof in
the cost af all proposed°work.
In no case shall the fee charged for any permit as set forth in Section 2 he
less than $5.00. '
VERIFICATION OF FOUNDATTON
NOTE: Permits for construction wi11 be issued a minimum of 24 hours from the
time of application, to allow for prope� review of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the fonndation, ance it
has been constructed, will be requir-ed before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Oceupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has bean
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued. .
r
♦
-- . - . S
,Surveyors �'�e�tific�te
COMSTOCK & DAVIS, INC. Consulting Engineers and Land Surveyors
1446 County Road J, Mpls., Minn. 55432, 784-9346
LOT SURVEY AND PROPOSED HOUSE LOCATION
LOT5 4A AND 46
BLOCK 1, HEATMER HII.LS
CI7Y OF FRIDLEY
ANOKA COUN7Y, MtI�BVESOTA
4?..5►►/�uAGE' �'",�s���,G,r-
�
/�
—�
L ` !�
! �p d
� ,�
`s
LiivO�'.PG,F'd�liu.D
LI ri<iry E"„�sE-�
1„�„?
�Ly� �
R� �
���,
O
��
W
,,� .���
;'
SURVEY FOR:
PE7E KEPRI05
SOUTHTW�INN REALTY
� � Vi o
�� O
I ,.,!� 3
�- t / '' S.�
�`� 3 a51� � 2�
o �R' �•
- ; . . t �yl / Qe.
23.'Z `, � �°R /,,,_�
N Q�
tA �/
Y / .
�
� '�
(,�r
�� , - �;,• �,�,.
9 � � -- �
� �„ , ^ /
� .�' ' '
DESGR�PTION; LOTS 4A ANp 4g, BLOCK I� HEA11iER HILLS, CITY �F FRIDLEY,
AtWKA COL�VTY, MINNESOTA. -
��� k
�.
SCALE: l�e � 50'
e DENOTES IRON MpNUMEtyT FpUND
O DENOTES IR�IV MONI}MENT SET
I hereby certify that this survey, plan or report was prepared by me or under my direct
supervision and that I am a duly Registered Land Surveyor under the laws of the State
of M�nesota._ _ _
�J .� -- ---- --- - - --- —� —
� /o83z �5'�> �3 �r`y 3�3z
Reg. No. Date Job No.
e _
..
-�--°�
� � � � � ���-�/o�
�
� �
� g S, c,�'� o �r� �f �✓,
e
9� 9, � � �
��� — ��� �� ��
�r� � �---- � ° _— �' �
�O
� - �� � . � �� ����� � 5
� o� ��� ar°�� �
�
�
�
�� , -�
�
l, � �
� � �. P �' d-..=�
�, C�
�, � � � � ��, �� � � �°�� c -�
w ?_--
. � _�
• '!
�
t��! ?� , .- HOUSE HEATING TEST RECOFtD
�� � � ����'�a.�.���� AP7. j OR CI� :
ADDRESS A � � �,� �v
OCCUPANT OWNER�
HEAT LOSS DATE HTG. INST. GAS CO. METER BAD #
SOLD BY INSTALLED BY
Eleehical Work By Gas Line By
TYPE OF HEAT GA FA HW STEAfA SPACE HTR. UNIT HTR. OTHER
� GAS SIGN y CONYERSIOW
MAKE _ �-�/ U ���`'� �"'`�'�`��KE OF BURNER
Model �� ,d'�� � �� � �� � �'� Model
�ia� ��p ��,�%�-� '��.�'� Max. BTU Rating
INPUT �'�-�� MAKE OF FURNACE
Model
��CONTROLS °�
THERMOSTAT -���'��at ���9 Vent Size , ��
Valva �� ` KIND OF LINER
� �SIZE NONE
- � �� -_�i�� Droh Hood % RegulaTOr
Limit Numbe
Limit Setting f� r Filters Size
� � �� Chimney Loeation Inside Outside
Fan Setting
Pilot Type ��°' G7�imney Construrtion
Pilot Nlaka `°`��' � �'�'
Smoke Bomb Wiring
Pilot Modef � � ��-- Test Tae �'�_
Pilot Timing // ��� DraR �
Door Pressure Lighting I�st.
L.W. Cut Off � � �� ��
� p 6
� � ���� � Date Tested - -
Pressure � ° Per ent �C
Input CFH ,� � � P�e� �"2``� � ��mP°ny Testing
Stack Temp. <��'�� Percent CO ,--�J�— Name of Tester
Form 235
z
�
�
O
z
�
�
�
�
�
N
y
�
V
�
0
�
y
Qd
N
O
m
�
m
�
� �
� ~
o ro.
7d
�
� �
�,
iG��
�
�
�
z
�
ro
�
m
�
� �
r N
o �
O �
o H
°z
�
r�-�,�,"� �' �' °
�Z
� e t�n o �°< c c °w � o b b ro �
Haaz � �� � r r xy w pr f+ �
�p ,..`�., ,_y., d G� � r H � z m � m n � n n c�mi �D o
Z z Z H m�� Z �� cwi � � o n a+ y ��' g c�i �
C!] L1 L] F-i W G] l4 1 .7 I .7 '.7 .'Y t+ R'+ R� (D .7 U!
L� (/� Vi Z � O tM�-� t�o M P+ O P+ � W p H F� r� 0+ f+
t�rJHHL'�') � NK t�i� tr � aw �'O �m � � M t!,a¢�
�a tr� trf o,� K" c� r 47 a tn 5� u� �o � rat rwi� � ot�
��� f� (Hn �qi
%� t-1 w 7e m �° �w-+ ~ o 0 0 0 [ r 7 �� W o rt
�n �o� mo ro o00 � ma�o
�� °om m ° �m � .m°omo ��u � b°r°s
''.9 o m w rt o ►�°�o �.0 �x
W,��', b° nc� ok �°o w� �
,�,� L4"' � � `o* � � w ,pa+ o 0
� o 0
�N � � �� c�'i�o 0
� � � o ° o
� k � � I I I m � C
� � W w kiCx �
� w
w f'1' tn v� <n tn tn r� �
� OF W t:� 00 6+�7r'�N �PJJ�taN
O 6 O O O O O O O O O O O O O
O O O O O O O O O O O O O O O
tn tn tn tn in tn in m in in tn +n +� vs tn tn t� yt t� tn v� +n
� N
� � c�
ro ° r°r �o
w � 5' �
� � �
� �
m m�
z °'
� �.
. , a
�
. �
H tA
� � � 90
O � 'C I
� I
0
1.3' w
�~
r
.� r
;�
:'�
�
�
G
z
y�l
�C � a �
O M �
�
N
� � �
�
iv
fi
W
�
t�
0
a �
� �
z czi
� � .
ro
�
z
�
. �,
� �rt
�
ra
°z
O �
�
a �C
n �
W n CJ
o a a
� � �
� �
�
O
o c�
� H
�
� o
G. 0
C7 y
c�i
�
�
H
�
�
�
H
O
�
�
�
g
0
�
�
d
�
.
�
�
00
C
�
�
h
�
� �
n �
� ��'�� �
z rororo� �
c' ���� a
R+ 71 ] � �
a ��rt�
� r+ cr o ►~-� �
y aa"rn°t � -u
,~�, oo�n� �
��aA —1
m � � D
,
aro y r �
�� � � r
rn �
W � � M
0 0 = O
p I"7'7 Z
o C O
� �
O
�
i„ m
r . �
� � � ro y a�
0000 CS1 �+ �
0000 �J
Z
l"') -1
tn tn v� tn O tI�
H C a
9 � �
r °z m
� cai a m r� ro
rtc� c� � � m
� G r�'n � � o �
a rw � �,nrn
a� w a r��°
rt m w r�s �, Np.� �
H MN µ OfD �
a ��+� a `��
f�D oFOair �
tj ��io•C
m � F�+
� ���
a � �� m
O w � �, � �
� wr,'X�O
O � � � � � .
am �
� � � w � O
• (b Of R p
�ramo
W 'J Q M
'�^ � M p� m
t p
a���
m a E �
wro
� � � k
� � � �
o a �c ir
� `� � a �
� '����'
-� a
� �
z
� �
� •
N
-�-7I C�
3 O
y N r
b" 3> Z
a :� a d �
ty C
� � m
m nr
n .-.
m �
�
-�! .
0
z
� `
N
o� m
I� �
(�p rn
� �
� �
� Z
f�D Z
d d
h
C
c�
s
c�
�
�
0
T
T
."O
C7
m
-� .
�
d
�
�
pEPP�RTMENT OF INSPECTIONS - 220 ORAIN EXCHANO[
� l'N� �OA� cweR � MINNEAPOLIS. MINNfiSbU Sd4/d �
�� .7 G�o � _ -._.-_ :---�
(sU �kt 0 B �!'1 'v` naa� _�� IV O/C � R
, y
Job Name '' -- --- , A � p. �. ..
� : Length �_ � Height . Time: - - '
Roan: Width - � �b ; Wet Sa�tb �
; Wet Bulb �d�': �'
Deaign Conditions: Outside: DrY Bulb ' - - - - - - ' _
Wall Color. Dark E�: L.i t Q: M� • --- -._ _---- i
Roof: Dark;�j^ L�t D: 11[edtum�� .
VYlndawa: Shades i� Awn1n ❑; Bare O. _--.- --_
------ ARfA � IA101! q
DINIiNf10N: SO. R. � � �* .
f1D• � ---- — — - --_ .
CONDUCTION NEAT �AINS ,* .. �a•s ••a .
1. Entert'or wall. Qross -- - � , y �', ? '�
2. F.�cterior � tia
3 Exterioc wa11, �t ! Z��� � p
wn
�. Partlti nrt ', ����
S. Floor! � '2 . P� �fr� �
g. Ceiling or roos ;
�(�� f2LAR OAIt�
WAUS (dinetisn faadl
�.
8.
�.
10. Raof
� �dIHCf�11 �
�.
�
�.
14. 3ky►lf�ts -
�Y M�AT A�
, c e�,..�h�.
18. Latent (9utet)
1T. Ltent (activa)
�11PA� I�T
� 18 E�ecFrtc li�ts
� 1�3. �lectric � (itotN
� � electria�l eq,ulpi
� _ - z�: - �e:: bu�ra;t�� �qc�r''�''
� � ���'�
S� L-- I -°. .'�� Z/
6/�
� No. d �eopi
(, �ad�
No. d �1
�i Watts x 3.�
� v d � � � �
J 2 �i� � �� o
�
X
H.�. ) � x� x Paw�er Fact+o�r I
�t r ,
C', �'. b,� a 1000
� � 9 � � �' .� n 'i.. �
ro �
. -� 0 � �
ns .
s
7 .� ...• - � '
..., ;�,;
�t
N�!
4
«N
l
� ��
I� '� ��e�
��� ,
r � NM
iM�
�
�
...� a� v
•ae
�� �
Zc�a
� o (�
�----�--
�
.s�
��--
.�
�
�-�
�1 '1'�'i'aL %LEA'r GwaN c:3r:r�i,s�.{.�, _— ' I .... � i .� -
23. T(�"fAL HEAT C;AIN (LA1'ETi'!') --- ------- -- ; x lOQ _ 91r
Etem 24 x 140 _ — i -
�. �ible h�at n�= Iterr► 24 + Item 2S _
_ _ —� -- — - Dt.y, bulb, �� �
2T. Temperature ot air supply _--- - --------- Gi.�
item i4 — -- ------ =
—
28. Total air e�u�ply= 1.1. [room d.6. - Item 27 d.b., I
— =-- - - _ --1-
-_ _ _ _ ---- -- — i
NE/sT IOAD O� YENITl�Ie11N�3 Alit C.F.'t. OuLdde Ate
29. No, at Peog�e -- -- --- — - � -- -- C.F_�i._ p�r �!�on _ -''� —
_ � __— B.T.V. p� hout _
30_It�t'n 29 -- - � - -B -T-U_ Pei' C.F'.M _ _ — _
_ - --- -- E.T.U. prc hottr
31. Totnl cooling load = Item 24 + Item 25 � Item_30 __ _ --- ��
- --_ --- - - - — - Item 31 � � / �_ � ��- _
32. 'Tonnage equivalent �d cooling load- 1� Z000
_.� —_
- -- - _- ;
--_ - -
, ,
SUBJECT P .
City of Fridley 2 0 3 7 0
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
� �
� � •
� i y___�� COMMUNITY DEVELOPMENT OIV.
r � � PROTECTIVE INSPECTION SEC.
� � �
�� �
i.---� �/"',,� CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE Of APPROVED BY
i' 612-571-3450 9t0-F15 5/18/�Q. / /
JOB ADDRESS �,26.6 B.en M,ore Dri�e N,E,
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 4F� & 4B 1 H:ea�Fier HJ,Z.ZS SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Walt Jacob.son 62G6 �:en More Dri�e N, E. 571--3794
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Deck Specialis:t 1238 rt�a,chtlex �env.e, St. �aul, MN 55118 224�25�2
4 ARCHITECTOROESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILAODRESS ZIP PHONE LICENSENO.
8 USE OP BUILDING
Re�idential
7 CLASS OF WORK
❑ NEW f�7 ADDITION ❑ ALTERATION O REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Constxtact a 394 �t�s �'t, Decrs_
9 CHANGEOFUSEFROM TO
STIPULATIONS
�ee n9t�,ti,cang: on �lan. The nlini3nucn dis°ta,nce Faetween the deck and the
xea,x ],at line. i::� 1�, 5: �,
t �������
� � �����t cat ons�r
46�-0002
_ R`ED By �qw
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATIN(3,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONIN(3 SQ. 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 CERTIFV THAT I HAYE READ ANO EXAMINED THIS APPLICATION �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SUiiTAX
AND ORDINAIdCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED 2 85I�
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $ I $�-.43
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- '
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $54.00
��,• (� ,� PLAN CHECK FEE TOTAL FEE
�J�' �—�.�'`►' �o, $55.43
S�GNATUREOFCONiRACTORORAUT ORIZEDAGENT �oATEi _ WHEN PROPERLY YALI ATED THIS IS YOUR PERMIT
�
���
SiGNATUREOFpWNERtIFOWNERBUILDERI IDATEI BLDG WSP OATE
�
� [ ]
�T� [ ]
. ti ., � ... ,� -
Legal Desc.ription:
EffeCtive 1/1/90
R-1 AND R-2
Building F�ermit Application
Owner Name & Ar,�dress: �, � � ��-�. �_ � :�, t`- - ,`�� �a, �� , o a���°: Te1. # ,� � � � � � �� �i
Contractor: � � � �� � �� � = .� n �.� Z�e1. # �� � � �'�'�;
'� ', =�" .
r,a.a,"c�.�t ' ��� ° e,�c �
� � �� �' � � � �� � :.i:� � - :'-i� r' � r" r`%-.� Pr°� �' ��
Attach to this application, a Certificate of Suzvey of the
lot, with the proposed construction drawn on it to scale.
LIVII�IG ARF�: Ierigth
(�►R� AREA: I�x�gth
DECR ARF.'�i: LL?Y1CJ�'1 _�� 1� 9�
�: I� �1 �
���i� 7 d.'1 � 2 SC y�%� a`�.
:�
'��
.,�:_ «• ., . - � �• •.. � � ��,
Width
Width
Width
Height
Height
�/�
Sq. Ft.
Sq. Ft.
�� �Y
Sq. F't. � ��°��-�,� G �� � �`�, __ �
�. .
��� ��������t�� � �
Cornex Lot [] Inside Ip [] �. Yd Setback r��� Side Yard Setbacks �, �� G° '��
'Ij�pe of Construction: �� . �^ �� �� , F�timated Cost: $ ;'�>� . �� � �
`
Approx. Caanpletion Date. �`,�,, ,,,;:; ����``�� ����.1
Proposed Driveway Width If New Opening Is D�ssired: Ft. $ ' $
Width + 6' See Back Fage
I]ATE: � � � �`�`' APPLICAIVT': ��� ,�.;, ,� . �J��,.�, Tel. # ?.'� �' E �_ �' � �.,
_ �f.� � '� ''� �� � a
P2rmit Fee $ .��
State S�um,harge $
SAC C�aYg� �
Driveway F�c,zo�w $
Park Fee $
Sewer Main (�aYge $
� s�s��
CITY USE ��II,Y
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined bY �J�'�J
Agr�t Necessary [ ] Not Neoessaly [ ]
���: �� � �� �� �
�� �' �� �
� � � � p�'��' `
�
2 ��
ZQ��--1C6'��
>�'� �,��____--.
�y, u �
:_�1� • ��_ ��+�Y�4 �+:�- : �.:i:��_�� :r,
The Ctiief Builditig Official shall, before iss�?*� �*�+++;ts for the e�ec.�tion of any
,; i ding or stxucture, or for ar�y addition to ar�y existirig buildirig or structure, or
for ariy alt.�ration or repair t� a� existing building or structure, upon application
therefore, rec� ��� the payment by the appl icant for such pera�it of fee5 to the amoimt
herein belaw set forth and in the manner herein pmvided to wit:
,'I�0►�1L VAII.JE
$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
E�� �
$15 (Minilmnn Fee is $15 plus sumhaxge)
$15 for first $500 plus $2 for each additional $100 or
fraction thereaf, to and includirig $2,000
$45 for first $2,000 plus $9 for each additional $1,000
or fraction thereof, to and including $25,000
$252 for first $25,000 plus $6.50 for eac� acklitional $1,000
or fraction thereof, to arid iriclt�ding $50, 000
$414.50 for first $50,000 plus $4.50 for each additional
$1,000 or fraction thereof, to arid including $100,000
$639.50 for first $100,000 plus $3.50 for each additional
$1,000 or fraction thexeof, to and including $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each ac'�di.tional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and t� $3539.50 for the first $1,000,000 plus $2 for each�additional
$1,000 or fraction thexeof
DRl�1E'f�iY DEPRESSI�T ESC1mW
(Concrete Curb Streets On1Y)
Alternate "A": Removal and replac�ment of curb ar�l gutter only - Driveway width plus
6 feet times $13.50.
Alternate "B" : Removal arid replace�nexit of curb and guttex and in.stall a 3 foat wide
approach with 6 inch depth - Dri�eway width plus 6 feet tia�es $15.75.
►'/�+; �� �+s M •)� • � ��,U,ie,;-y�-i;�l
P+ermits for oonstruction will be issued a mZnim�nn of 24 ha�urs froan the time of
application t.o allvw for proper review of the proposed structure and of the
oonstruction site.
A Cettificate of Survey of the lot, shawing the location of the f�ation on� it has
it has bee.n oons�suct.ed will be required before proceeding with the fraining.
Surveyors Cert�fic�te
CO1�iSTOCK & DAVIS, INC. . Consulting Engineers and Iand Surveyors
1446 County Road J, Mpls., hiinn. 55432, 784-9346
LOT SIiRVEY ANQ PRQPOSEO HOUSE LOCATION
LOTS 4A AND 46
BLOCK 1� HEATNER HILLS
CITY OF FRIDLEY
ANOKA COUNTY, MIIVJESOTA
D�A/�uAGE' F�s�rfe-,vr�.
� } �o�
—�--� —
�� /i
�%• �'i
� I
;� �a
L 1- � � .
�
Z �
C N x.
SURVEY FOR:
PETE KEPRIOS
SOUTHTOWN REALTY
✓
�`;
..-..
(
Q v I � N�� W
N �o• ��• � tt .
:Z ' �, yy '�,
_o � " I � W �°
lS�
UNDE,PG,(�d!�iVI1 g� � ~� ��
UT/.C/iy �sE'Y�Ei�T }). �\e- I /� Z��� Z/°'S
� �s/'� 3°j'��7 R' t'° .
\ � 4' � b'f � ��-�'
3 �Z �s �,Io� l '
2 H � �N
�
� �
. �
1 �, v 1
� ..I" .
9
DESCRIPTION; LOTS 4A AND 4B� BLOCK iI HEATHER HILLS� CITY OF FRIDLEY,
� � AI�OKA COUNTY, MIfVtrIESOiA.
t' . . + , .
,
; ,
SCALE: l�� = 50'
O DENOTES IRON MONUMENT FOUNO
O DENOTES IRON MONt�1ENT SET �
I hereUy certify that this survey, plan or report was prepared by me or under my direct
supervision and that I am a duly Rep,�stcred Land Surveyor under the laws of the State
nf Mi��nPCnta
�
ROPERTY LINE ---�
yo
feet
SITE PLAN
feet (lot width)
�
�feet
feet
,
... �.�i .,._.�u�
feet
feet
(lot depth)
NO SCALE
°,.::�.>r; .� � 7�- � '- -, � f�* .�C,-�
STREET/AVENUE
0
SHOW NORTH DIRECTION
,-r.��.
BUILDIAIG SPECIFICATIOI�IS for PERMII'
S��1 �� D� V � ta�
�o-9s4o
CUSTOMER 11�AMF' �. ��� t�+- `�:��-• � nl�c; � r� CITY t,, e 4 l t�. w �
ADDRESS ��G��� 1��t..��rr,<�,�� 4�;�' TEL# a�")s� �"a`�"`�
SALE DATF SLSM _ .�..� � ,,4. � :�. d �� �:
APPBO% TIME WOBB TO STABT (WEATHEB PERMITII�IG)
FOOTIleI6S
number /� �
�epth �1�.9
�iameter � p�
�� � I � � c�.�� :,1 �.
LEDGEB`
:71at I � �fCl �C�° ��
;pan. e � �
�iding type����
DI11�iEI�ISIOI�iS
�r1at
;ength
width
height `� ' � � � a� �
EXTI�AS
:�enches "�
�irr�en�ions
�tyle
SUPPORT POSTS ,
mat ��z;! a,r �:�'���
lengt� �`
width � � � "�
JOISTS
mat 'i r��s --�� � . !.
gpa +�,i'v°� ic'. `_'�". (�am ° �,e Fs
X6 2X8 2 1. X
„ C �� „
STAIRS
mat L�Y.4+`�� •
rlse � ° 0
run r � �
eleVatlOn �° `
planters -��
dimensions
style
FII�IISH UrIDER DEC�' r'1 t.�►°��` '
�BSTRUCTIOI�IS
SPECIAL IIIISTRUCTIOI�IS
�
JOIST
'JOJST HaN�AR
H�JSE
SUPPORT BEAM
,
mat �- �� �'' �
P � ��'
s arL � .�:,b., ;., :, ,, M �:., � �; , .
tl
4x6 4x$ �4x10 4x12 ��� ,
�.� �._, r 1.;�
FLOORIRIG � �'' �- "" "`� '
A
mat � �� �e �-
len�th � �-� ,,a �° --
diagonat
other ��� �E�� <�.���_
RAILINiG
mat � �:i ,;� -� r
ht ' `` °,�. �'
spacin� -c� �� -� �=�
style �; � 4='t�
trellis �
dirriensions
s�yle
�
1� I �
i . � ' e, .. .
GRADE --`J �
� �
CoNCRETE Fov1��N67 � ,
�
4.� Cy �
�
/1,,. , , �
. . ` . � I
i_; �{� � �0� "J1 � �
. . � ' ..
P057'
�
,'� n.1 t....
��q < <J to
.�,�, r�i ll �( ` .
1 A.�=
i° .�!' 's_
�R►PPAB�.�'r4 Co�E
— —�
STI�lR RAI�
�
�s'.
�
�T '
'" ; � � � . 4� �
�_� � . a •-
.� �: • i . ` � s i �� , t�+
.� � ' � �'� —
1�1 , s ; ; t,'� � d
� � r+ - + I � , p°' f`s. � . `°� ��3 �.� � c 9
� ; � e 1� , e' *� a � •', t� °i�
(� � i
G � � � _� .. � � ``1 i� • "' . /.� "" �' :. � f �.o�
� f __ I __-.r I _.__� . �_ _ _ -. 0 1 � 4 � r �i
� � ��; -. _ ..�
�--�— -�----}- 1 i - ' - �—� � ��=� ' � � � .� � �
`'� � �'''1 � � i ' � � . ' �n ; � � ;�.
},i--�� �- -� i 1 , � ��; , S .
� ' � �'�'
- � ---- � - � �
�!� �_� { --�-- ' - , • � ( �
� ,
� � � ' I I ! � � '� ,� ,
i
' � ' -. � � .1 � � �' ��
_� �' , _ ' � .
; : , � a� � ,�
� ,� � ,,,
�--�-�- -- : � - �. � . �� �� �
� � _z
i � , I - -
4 i
{— + - , ' ,
i - I - -- - i � i �� � � ; ��� '
� � I i � R
, - Q, �,� `,
_; _�_ � i _ _ _ I _� _ : 0 , ; . _ � _ : -ro=
� � ---i- ,� , ,'; N i
! ; �� � I : , ;� •- _.. �`�
� � � � ,�
, .�
� i _t �� � ��°. �' . .�
� � - `a ! � � �
d,E
� — �_ —_ � il b J �
� ^ �
I I 1 I � o� 1 I �� ' � `.
�► , 1 "t�.- h
` _ � � ' ��" 'r � 6
i � � � i
Yj �
, � � ! '� � !�� �� -�' �� .
li ; ' � � � a- �s r
; - ; - � - : i _ ; e�,l ; , �', , q, L�
- ; -' � f i ; , � � ,
I i ' — - - ! I �, �,, �� ��� �
+- � - -;-- �- - - - � i I ,� ,,° ,
I � / �
• �� --- -��- - ' ---- � - { ! � ' I � '�g '
� 1_ _ � - I - I --� --� ' -.5�� - ���;� ,c�a. .
i i ; � � � � :
' � - �-- - - -- � --1- � i - I ; � �
I
I ' '
�
, ;—� i � t
� , _�_ . � _ �'�
--�- - - = � ..
_ i � � i � , f� ,
;� ; � �
� �
��
- �
''� -� — � � -_ _� -- .
-�- � _ �- - �,�
-� - a� � - , ,
- - -- , _ _ . _ _ -
. ,
. � �
�
�
, ,
� __ � . _ : _ �. � - - �--
�' L ; '�' i— , , ; , , ,� ; w� ,
� .: ` �
; ' ' - �
-! — - - �� .- �,i
� � = -fi � � • � - ;
` 1 - - }-- 4 � �''g,� � - - � , ��� y�� - I� �
I i ,
— - - �s. i .L� j i .'�,�n�4 � - � ,
� � � I � �
�
— A - -+-_ -_ . : �
i t- , �
- ��-�- - - - - - ' ' i
; , �-_; , �, � ,
--�--� -!- � - -- -- ; - ,
I--I � f
� ' ,, _:_- � -__� ; :� �
� a ; -- , , � '� , ; � � ,
, ,
, �
= -- � � � _ ,_ , �,�.
� J''- �- ' I - I � � _�g� , �J � .
- 1� f -r--- �-�
� _�_ ' '
�
, ; ;
�-- � � - ; , �
� � � �;
f � �i- -- � -�- ; � i .
��-'�il -�-�-- }- i _I I , . '
�:.o� � ,� � q� � 7 ;
,; ; ;_I_�_' ; i � , ' . ' ;
: � �
��
. ---
. �� � e
�
� .'' .
2 .
!
I
. : ,
i
,
,
. ' ; .
- -- l°; ;
1 , : .
;_ � �
��
- , , . , _ . _ ,_ __.
� ; ; ;
__; ; �, _�_ .
,� ,
_! ; � ; -
� ; ! �� r � 1
V i I : . .
� : : : .
; _
,
�
sue�eh
City of Fridley 2 8 8 8 5
�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
„
,� .
; `L __�__ COMMUMITY OEVEIOPMENT DIV. ���
r � � PROTECTIVE INSPECTION SEC.
�
i . ,
� _ �"'� � CITY HALL FRIDLEV SS1�2 NUMBER HEV DAT6 PAGE OF APPROVED BY
�----�% ,•' 612-571-34b0 910-F15 2/2/99 / /
J08 ADDRESS 6266 Ben More Drive NE
t LEGAL LOT NO. 9LOCK TRACT OR ADDITION SEE ATTACMED
oesca. 4A & 4B 1 Heather Hills SHEET
2 PROPERTY OWNER MAIL qOpR�$$ 21P PMONE
Walt Jacobson 6266 Ben More Drive NE 571-3794
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO
Kn.utson Roofing & Siding 9307 Hillside Dr, Champlin, MN 55316 323-9238
4 ARCHITECT OR DESIGNER MAIL AODRESS ZIP PHONE UCENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK �
❑ NEW Q ADOITION O ALTERATIpN �] REPAIR O MOVE O REMOVE
8 DESCRBE WORK
Reroof House & Garage (25 Sq) � Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS "
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOF ELECTRICAL, PLUMBING. HEATIN(3, TYP� OF CONST OCCUPANCY GROUP OCCUPANCV LOAO
VENTILATING OR AIR CONOITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 20NING SO. FT CU FT
AUTHORI2ED IS NOT COMMENCED V�!ITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED fOR A PERIOD OF 120 DAYS A7
ANY TIME AFTER WOFK IS COMMENCEO. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV 7MAT I HAVE REAO AND E%AM�N�O TFIIS APPLICA710N STALLS GAfiAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS QF LAWS ypLUATION SURTAX
AND ORDINANCES GOVERNING TMIS TYPE OF WQAK WI�L QE COMPLIED @
WITM WMETMER SPECIFIEO MEREIN OF NOT. TME GRANTING OF A pERMIT W2a 142 �I.O7
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CAMCEL TME pEWMl7 FEE SAC CNARGE
PROVISIONS OF ANY OTHER STATE Ofi LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION �%1F.75 Fire SC �Z.I�F
_ PLAN CMECK FEE TOTAL FEE
License SC $5.00 $82.96
o S�GN4TUAEOFCON7i7ACTOpOAAU�NOp4EDAGENT iDAiE� MEN PROPERL� VA TED THIS IS YO/U�R PERMIT
�
P '��S�GNATU�7E O� OWNEQ��� OWNEABWLDEA� id�ig� � B�OG i�SP ' � q�rE
>_ _ �'�'
x�w
ADDN
ALTER
[]
[� l
[l
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERNIIT APPLICATION
Effective 1 / 1 /99
� �� -
�������
�
ConstructionAddress: 7���� � � ��, � � � �
Legal Description: _ � 1 � � � �� ,�t 2 �o i ��,•1 �� `�c �
Owner Name & Address: G✓�r 1�- T� ��sc� Tel. # S' 7/ —� T�c/
Contractor: � �c�� �'.s'ipt �'Yt MN LICEN5E # ��-G �
Address: l % ' e 1/e � %% �/�/� Tel. # 323—gz��
LIVING AREA:
GARAGE AREA:
DECK AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
Length Width
Length Width
�n� , w�a�n
�ieight Sq. Ft.
Height Sq. Ft.
Hgt/Grou�ad Sq. Ft.
OTHER: � � 2 ��C� Sc� � °�- �}� � �
. �
Construction Type: ���( p�,� �',�� � Estimated Cost: $ __ � � �/ �
(Fee Schedule on Back)
Driveway Curb Cut Width Needed:
DATE: � Z APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
�D L/ ��
$ � /y
$ /• c� �
$
$ S"�4 0
$
$
$
$
$ �� ��
Ft. + 6 Ft = Ft x$
S�L 1� ���Gr��/1
CITY USE ONLY
Fee Schedule on Reverse Side
�
Tel. #� 3Z 3--�Z�
.001 of Permit Valuation (1 / l Oth %)
$.50/$1,000 Valuation
$1050 per SAC Unit
$S.QO (State Licensed Residential Contractoxs)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
BUII.,DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing psrmits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any eacisting building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in 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
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alterna.te "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alterna.te "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permi�s for construction w�� be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.