AF - 37007BUILDING PERMIT
Village of Fridley, Min.n. N� 2 514
Date � ;r„ �'"�'' kr,�, .�.�t :�:' . . . . . . . . . . . . . . . . . . . . . .
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Owner .. ���',�:'.... �: ........ Builder r�,����.d ........................
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Address......................................... Address .........................................
LOCATION OF BlJILD(NG
No. ..�r.���.�:... Street ..,���'�'. .�.�.' ��,;� .................. Part of Lot .......................
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Lot ... .... Block ................ Addition or Sub-Division �'��
..�..�.. ;� �'�;�"�'�. .�,�.�5........ ...
Corner Lot . . . . . . . . . . . . Inside Lot . .�. . . . . . . . . Setback �,.�„�'.�,��� . Sideyard .�p��, ���� ' . . .. . . . . . . . . . . .
a•
DES�CRIPTION OF BUILDING
To be Used as:
,, yy . . . . Front . . Depth ��, . . Height �r.�,� . . .. Sq. Ft. .�� �. Cu. Ft. . . . . . . . .
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�' ��, . . . . . . . . . Front ��,,.�i'. . . Depth � .�. . . Heiglzt ��•� d . . . . Sq. F't. � t? � Cu. F't . . . . . . . .
a �� �
Type of Construction �.� � � z.�, . . . Est Cos����•�� �� .� . . . . . . . . . To be Completed *�.��� ��`�. . . . . .
e��.
In consideratian 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 a11 provisions of
ordinances of the village of Fridley.
,
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— ,� _ ��' � +���
In cofisideration of the payment of a fee of $. .,� �,.. , permit is hereby granted to ......_�; :� �' ,
.- -. .....
.�•:, -
........
. . �� . . . . . . . . . . . . . to construct the buildin� � ad dition as described above. This pe�rdY�` granted upon
�_ � � � �3�ti�
.��'� . o " that the person to whom it is granted and his agents, employees and worlmzen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
F'ridley, Minnesota. regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limi4s and this permit may be revoked at any time upon violation of any of the provisions of sa.id
ordinances. � �
. .°i ��,•r, . . r� �T. .:r-. s , '-�''•.+!;t':9�:.:�Y� •
��"° �`' �
. Building Inspector
NOTICE:
� This permit does not cover the construction, installation or alteration for wiring� piumbing, gas heating,
sewer o� water. Be sure to see the Building Inspector for separate permits for these items.
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SUBJECT P •
c�ty of Fridley 210 2�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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� ; y _____ COMMUNITY DEVELOPMENT DIV. �
r � � PROTECTIVE INSPECTION SEC. /� ,lr�i
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� �'�'1 � CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OP APPHOVED BV
�"'"� � ,'� 612-571-3450 910-F15 8/26/91 � �
JOB ADDRESS 6745 Channel Road NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACMED
DESCR. P't. 4B Second Rev. �X Auditors. 8ub. #2]. SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Mike Steinbring 6745 Channel Road NE
3 CONTRACTOR MAIL AODRESS Z�P PHONE LICENSE NO.
Belair Builders Inc. 443 - 8th Ave NW, Ne�a Bri fiton 55112 633- 4
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO.
5 ENGINEER MAIL ADORESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW C7X ADDITION O ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WOHK
Construct a 24' x 14' Decky a 6i x 4'' Deck d'ndow Re lacement
9 CHANOEQFUSEFROM TO
STIPULATIONS
5ee nota.tions on pla,n.
INAR�!l�IG
Before digging call for
all utility tocations
454•0002
REQUIRE� �Y LAV��
TYPE OF CONST. OCCUPANCY (iROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIREO FOR ELECTRICAL, PLUMBING, HEATiN(i,
VENTI�ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWL(3. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF IAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $4 f �-�� $2 "Q8
DOES NOT BRE UME T GIVE AUTHORITY T VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISION O AN H STATE OR L LAW REGULATING CON-
STRUCTIO O TH P F MAN F C RUCTION. $72 e QO Fire SC; �`4. ZrJ
PLAN CHECKFEE TOTALFEE
`' ��L'' $ , 23
IGNAT RE OF C O OR AUTHORIZED AGENT �DArE� yy PROPERLY VA ED TH S YOUR PERMIT
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SiGNATUREOFOWNER�IFOWNERBUILDER� IDATEI `� BLD iNSP nATE
t.l I I U� rr•.�..���i �CL• ti��t:. �.�i 1—l.�vi 1-1U� lUaJl +:i•4U IYU.UV� f.U�1� lJ;i
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Build�g P+e�,t�aft l�ppifc�tiat►
Effective 1,/],/91
�ttUGt�Ct1 �dc�'+�t45; 6745 Channel Drive '
The south 75 feet of the west 156.82 of Lot B Secon revis on
I�d1 �j7'�.Ch: of Auditors Subdivision No. 21+
�t. N�e �i Addl"255: Mike SteinbrinQ Same as above �. � 574-17G.7
(�Gt�: _ Belair Builders, Inc. '�7,. � 633-6944
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Al�S3: 443 - 8th Avenue Northwest New Bri hton MN 55112
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Jittaah to tl'�f.s �plit,x�tian, s Oertfficate of S�rvey of the
lat, v�th ttie pYapc�d aonstruc.tian cbrawn an it to scale.
�r+�d �a�
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�ti3 24
k Area_ 6
'�'=�i �'�� •. •i' �,�;r:�:/JY�s��
w�atr, ,�
Width �_
Wjdttl _ 14
H�eigt,t
Heic,�it �
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Sq. Ft.
Sq. Ft. �
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sq. Ft. ��4 -�36
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3(��' �,� � l��F�.6� � �Z�a 2 y,��.b� �� �
�'S if.�t (� InSide �(X Fk. d P1anSite , S3.de Y3rd Sc'tbaCkS
, ec ,
�i�e Qf �t1�CtlG�'1: Window Revlacem n�, t_ ESt]m3GBd a,�Et: ��,�$�p �/ I�
�pp�C. OOt�lE'k�Ci'1 l�t�?: Sentember 15. 1 91 WI�ID�u�-' ��r�.ac�-�ti�,�ti`Z v`�u� ;
- Z�S'C? 6
P�cc�o�c3 C�iv�ray Width If New Oph.riir� Is L�esi�d: N a F't. $ $
i��.dth + 6' See E�c�c P�ge
11��i',E: 8-22-91 ���r; Belair Builders, Inc. 're1. � 633-6944
F�xmit Fe+� $%� a 0 C� _
F�i.t�e S�rge � �I , i �
state sut�l� � a, 0 8
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n�iveway �row $
Park Fe�a �
Sewer� M�in Chaxge $
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!�e Sd�a�1.e az Reverse Side
.001 x Pexmit Valt�ticn (i/lOth �)
S.SO/$i,000 valuatian
5650 per s�c thtit
Alt. "A" ot 1�1t. "8" Above
�1ae �d bY �gii�eering
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sue�ecT PERMJ_ ._
c�ty of Fridley �' �� ~2 213 0�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
� ` RECEIPT NO.
� `� __�__ COMMUNITY DEVELOPMENT DIV. r ���
r � � PROTECTIVE INSPECTION SEC.
� ` �
� /"�'1 � CITY HALL FRIDLE� 55432 NUMBER AEV. OATE PAGE OP APPROVED BY
�"'"'� � ,'� 612-571-3450 910-F15 9/23/�3 / /
108 ADDRESS 6745 Channel Road NE
t LEGAL LOT NO. BLOCK TRACT OI; ADDITION SEE ATTACHED
DESCR. 4B Second Rev, Aud, Sub. #21 SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Michael Steinbring 6745 Channel Road NE
3 CONTRACTOR MAIL ADORESS Z�P PHONE LICENSE NO.
Western Remodelers 2520 W Larpenteur, St Paul M[�TT 3847
4 AfiCHITECT OR �ESIGNER MAIL ADDRESS ZIP � PNONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE QF BUILDING
Residential
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION O REPAIR � MOVE ❑ REMOVE
B DESCRIBE WOHK
Install Fascia & So,ifit
9 CHANGEQFUSEPROM TO
STI PU LATION S
Provide adec�uate attic ventilation, �rovide smoke detectors as per
UBC 121Q a.djacent to all sleepi.ng a,reas and in bas.ement.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIFiED FOR ELECTRICAL, PLUMBING, HEATIN(i,
VENTIIATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SO. FT. CU. FT.
AUTHORI2ED 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 �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL PR041SIONS OF LAWS VALUATION SUFiTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOHK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S3 R OOO $I. s SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIO�ATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
S7RUCTION OR THE PERFORMANCE OF CONSTRUCTION. $S4,OO Fire SC $3.00
PLAN CHECK FEE TOTAL FEE
License SC $5.00 $63�50
SIGNATUREOFCONTRACTORORAUTHORIZEDAGENT IDATEI WHE OP VALIDATED THIS IS OUR PER
� -�3_
SiGNATUREOFOWNERiIFOWNERBUILDERI �OATEi - DG ��AT
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CITY OF FRIDLEY
SIN(iLE FAMII.Y AND DUPI.EXES R-1 AND R-2
Building Pennit Application
Construction Address: � ,� � � � �('�,��� ��'�
Lega1 Description:
Effe�tive 5126/93
� —
Owner Name & Address: �1 �, � �.i�� � j i���.� J %i �� Tel. #
Coattactor: V� �� �'.F�, ��„� �i�' � (�i�� '�� �� � MN LICENSE # � G�
Address;�.;�:� �' � �`�2 ( ��'�'V V � l,�}�L � Tel. # (�/�-.-�
LIVING AREA: Ixaigth
GARAGE AR�A: Length
i � �,M, : �
�THER:
i.ength
. .n �, �
Atta�h to this application, a Certificate of Survey of the
lot, w�ith the propa�d a�ruction drawn on it to scale.
DESCRIPTI4N OF IlIRPROVEMENT
�
�dt�t Height Sq. F�
Width Height S�. Ft.
Width Hgt/Gro�md Sq. Ft.
Corner �.ot ( I Iaside I.ot [ l Ft. Yd S�ck
Type of Conslruction:
Approx. Co�letion llate:
Side Yard �etbacks
Estimated Cast: $ '�i ,
(Cact on Back)
Driveway Curb Cut Width Need�: F� + 6 Ft = Ft x$
DATE: �- Z � � � � APPLICANT: Fr. �
� ��
�e
`�-f CITY USE, ONLY
Permit Fe�
Fire Surcharge
SYate surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sew� Maia Charge
TOTAL
s �`� �c�
s ���
� �,��
$
� �,ULa
$
$
$
$
� �.�.�
F�e Schalule an Reve� Side
.001 of Permit Yaluation (1/lOth�)
�.sai�i,000 v�u�a�
$750 per SAC Unit
�$
$5.00 (Sta,te Licensed Residential Contractors)
Alt. "A" or Alt. "B ° A�ve
Conservation Plan Review $450.(N?
Fee Deternnined by Engiaeering
Agr+eement Necessary {] Not Necessary [ �
STIPULATIONS:
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any buiiding or structure,
or for any addition to any existing bnilding or structure, or for any alteration or repair to any existing
building or structure, upon application therefore, require the payjmern by the applicant for such permit
of fees to the amount herein below set forth and in the manaer herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,�
$25,001 to $50,000 � .
$50,001 to $100,000
$10(},(JOl to $S(�,000
$500,001 to $1,000,000 .
$1�,004,001 and up
FEES
$15 (Minimum Fe� is $15 plus surcharge)
$15 for first $500 plus $2 for each additional $100 or
fraction thereof, to and including $2,000
$45 for first $2,000 plus $9 for each additional $1;000
or fraction thereof, to and includiag $25,000
$252 �for first $25,OD0 p�tas $6.50 for each additional $1,000
or fraction ther�f, to and including $50,000
$414.50 for first $50,0� plus $4.50 for �ch additional
$1,000 or fraction thereof, to aad including $100,000
$639.50 for first $100,000 plus $3.50 for each additional
$1,�0 or frac.tion th�eof, to and including $500,(Ml0
$2039.50 for the first $500,�0 plus $3 for each addifronal
$1,�0 or fraction thereof, to and including $1,(m0,0DU
$3539.50 for the first $1,0OO,OQO plus $Z for each additional
$1,000 or fraction �thereof �
DRIVEWAY DEPRESSION ESCRO�N
(Concrete Ctirb Streets Only)
Altemate "A" : Removal and replaceme� of aufi and gutter only - Driveway width plus 6 feet times
$13.50.
Alternate "B": Removal and replacement of curb and gutxer and install a 3 foot wide.
approach with 6 iach depth - Driveway width pins 6 feet tiYnes $15.75.
VERIFICATION OF FOUNDATION
Permits for coas�tructioa will be issued a minimum of 24 hours from the time of application to allow
for pro�r review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been
constructed will be required before pror,�ding wii$ the framing.
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City of Fridley
AT TNE TOP OF TNE TW�NS
r
� �
� ; v _____ COMMUNITY DEVELOPMENT DIY.
r � � PROTECTIVE INSPECTION SEC.
1 . i
i__-.� ��"' �'� CITY NALL FRIDLE� SS132
i 612-571-34b0
�U ILDING PERMIT
NUMB6N NEV DATE VAGE OF
s�aF�s 3/29/00 / /
JOB ADDRESS 6745 Channel Road NE.
1 LEGAL ��T NO. BLOCK TRACT Oq ADDITION
DESCR. !}B Second Revised Auditor`s Sub. 4�21
2 PROPERTY OWNER MAIL ADDiiES$ Z�P
Keith/Linda Petrick 6745 Channel Road NE
3 CONTRACTOR MAII ADDRESS 21P
Suburban Exteriors 9701 Penn .4ve, Bloomington, MN 55431
4 ARCHITECT OR DESIGNER MAIL AOORESS Z�P
5 ENGINEER
Residential
7 CLASS OF WORK
❑ NEW
MAIL ADDRESS
� ADDITION ❑ ALTERATION
8 DESCRIBE WORK
Reroof House & Garage (22 Sq) Tear-off
9 CHANdE OF USE FROM
TO
"�0773
RECEIPT NO.
/ ���
�dvqOvEO Br
SEE ATTACMED
SHEET
571-1528
PMONE IICENSE NO
881-8232 4289
PMONE LICENSE NO.
21P PMONE
� REPAIR
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARA7E PERMITS ARE FiEOUIRED FOR ELECTRICAL, PLUMBING. IiEATING.
VEN7ILATING OR AIH CONOITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING
AUTHORIZED IS NOT COMMENCED V�1ITNIN 80 DAYS, OR IF CONSTfiUCTION
OR WORK IS SUSPENDED OR ABANDONED POR A PERIOD OF 120 pAYS AT
ANY 71ME AFTER WORK IS COMMENCED. NO. DWt,G. UNITS
I HEREBY CERTIfY TMAT I HAVE READ AND EXAMINED TMIS APPLICA710N 1
AND KNOW THE SAME TO 8E TRUE AND CORiiEC7. ALL PROVISIONS OF LAWS yp�UAT10N
AND ORDINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMP�IED j� 923
WITH WMETHEq SPECIFIED HEREIN OR NOT. TME GRANTING OF A pERM1T �
DOES N07 PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THfi pEqMIT FEE
PROVISIONS OF 1�IY OTHER STATE OR LOCAL lAW REGUTATING CON• ��9.25
STRUCTION OR � E PERFORMANC OF CONSTRUCTION
PLAN CNECK FEE
, �� ' .
�/�� 1 G�� / ���Z'� License
� S�GNaTUpE OF CON'aACTOp Op vU MOp�IED AGENT IOATE� u D01
�O�rE�
occuPnr,Cr
STAILS
��
NO
O MOVE O REMOVE
CU FT.
OFfSTREET PARKING
GARAGES
SUflTAX
' $.96
SAC CMARGE
Fire SC .92
OTAL FEE
$77 3
IOAD
�� �
ADDN [ ]
ALTER �]
Construction Address:
Legal Description: �
Owner Name & ddre
Contractor
Address: ���
LIVING AREA:
GARAGE AREA:
DECB AREA:
O'THER:
�l(��m5�2- ��0�
Effective 5/10/99
CITY OF FRIDLEY
SI�i TGLE FAi�.Y Ai�TD DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
�
��� I
MN LICENSE #
Attach to this applicadon, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Ixngth
��sc�aorr o� ��aov�rda
Width
Width
�Width
� ,����,
Height Sq. Ft.
Height Sq. Ft.
Hgt/Ground Sq. Ft.
� ��--��� ��ti�°�'
l �1 "
S
Construction Type: /I�,��� Estimated Cost: $� � l%�_�
Driveway C�u�b Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ .
DATE: ��� D� APPLICANT: %" � Tel. #���°���Z
Permit Fee
Fire Surcharge
State Surcharge
SAC Chazge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �� -�S
$ /, i'.�
$ � � �,
$
$ �-�1�
$
$
$
$
$ � % /3
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Resiciential Contractors)
Alt. "A" or Alt. "B ° Above
$450.00 Conservation Plaa Review
Fee Determined by Engineering
Agreement Necessary [ ) Not Necessary [ ]
P �
BUII.,DING PER11�II'T FEE SCHEDULE
The Chief Building Official shall, before issuing permits 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 existing buildin� 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: �
$1
$501
TOTAL VALUE
��� �'v �"� � 9� 0�'�
��.s �XrT or-�-�����.�a /G�
to $500 $23.50 �� ��;;�:�.� �� -ST /_D
�T LG��7" ori/ L�
to $2,000 $23.50 for first $500 plus $3.05 for each additiona $100 r�
fraction thereof, to and including $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,OW,0p1 and up
_ _ _ $69,25_for fitst $�,Q09 plus $14�QQ for each �ddihonal$1,QJ0
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each addi6onal$1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.Q0 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
�1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1, 000 or fraction thereof, to and including $1, 000, 000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and replacement of curb and gutter and instail a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Perinits for construction will 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 construcied will
be required before proceeding with the framing.
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NOIl�d�Id1213A allol NOI1Sf19W0� aNV a01�3NN0� 1N3A 1N3A NOWWO�
NEW [] CITY OF FRIDLEY Effective 1/1/2003
ADDN �] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERIVIIT APPUCATION � o� ���
re��
Construction Address: _:� % � ,� �" /�i � e�� �' �. �, � � �/, � ,
Legal Description:
Owner Name & Address: _J� ►� � T it E e. +�r �n � F� �L i R i e F-c Tel. # 7 G 3�2 � S- `� 7 3"7'
Contractor. + " � ^'L � �S .;� �.f (�d �.�-�. s � � X i ►�. � � o rC S MN LICENSE # 2 0 :3 � / $ � '�
Address: 2 R� S G c� �� �� i f� Y 7�2 , L r TT �. � C��r� ��► s"' h' � Tel. #�� �,�� �(G
5 S� i �
,4ttach to this application, a Certificate of Survey of the � J)
i��t, with the proposed construction drawn on it to scale. ��
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Lengtii Width Height
Lengtl� Width Height
Lengtli Width HgUGround
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: �, S �� �ti � oP+ �, v � �, �o � Estimated Cost: $ � � ► � g � � � �
Driveway Curb Cut Width PJeeded: Ft. + 6 Ft = Ft x$ _$
� a �i��
� �I o .
DATE: �� "��`� � APPLIC`ANT: 1 D�- 3/� K iz �2. Tei. #�-5 ��7 7 G`�3� L�
Call (763) 572-3604 for Permiit Fees.if mailing in application. Fax to 763-571-1287 if using credit card and �ve will
call you for card a�umber.
CITY USE ONLY -
� ^ ,�Permit Fee $ �� s�-� Fee Schedule on Reverse Side �^„
Fire Surcharge j,��$ ' .001 of Permi� Valuation (1/10th%) �•�, ����
State Surcharge �,�j$ �. ,� $.50/�1,000 Valuation l� ���
SAC Charge _$ $1275 per SAC Unit ��j -
License Surcharge�r� �5� � $5.00 (State Licensed Residential Contra
Curb Cut Escrow $ �' Alt. "A" or Alt. "B" Above
Erosion Control $ /
Park Fee $ �e'
Se r Main Charge $ /
�� zc.a �4��ti�' --�� .��
TOTAL $ � ��° B �I �C
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [
s�_
���,- ����
�esmi! No.
40
514
894
373
623
727
.'1,028
2,130
_,261
0,773
5,299
Constructioa Dat�
uilding Permit (House) 9/9/52
uilding Permit(H&G) 6/17/57
eating PeYtnit 8/27/64
Lumbing Permit 7/20/67
lectrical Pextnit 6/22/73
�ating Permi.t , '7
�,ilding Permit(Decks 26/9
uilding Permit(Sof/
lumbing Permit 1/10/95
iilding Permit(Reroo �f�pa�
�ating Permit 10/4/02'
J
�
/
i
Contractor
Ed Erickson
Ed Erickson
Frank's Heating Co.
Minnegasco, Inc.
--- ----- -------------
Rob Holmgren
an xteriors
Air Mechanical Inc
w •
I$
Cos!
11.25
14.00
6. 50
3. 00
4.00
23. 00
72.00
54.00
15.00
69.25
30.00
Fiaal
1/10/75
10/18/91
i 1/18/95
3/3/100
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