AF - 37020� SUBJECT PE 14233 ��
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T 1
�
� � RE idQ:
� ; y _ COMMUNITY DEVELOPMENT DIV.
r � � • � PROTECTIVE INSPECTION SEC. ����
1 . i Cl
� � ��"1 � CITY HAIL FRIDLE� �55432 NUMBER REV. DATE PAGE OF APPROVEO @Y
�.---� � �'� si2-56o-3a5o 910-F15 7/22/T7 � �
JOB ADDRESS 6816 Channel Road N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2], Bl''OO�CV].@W Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Vernon Overland 6816 Channel Rpad N.E. 571-0753
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO.
Sc�
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADORESS ZIP PHONE LICENSE NO.
B USE OF BUILDING
R2 Slfl@Iltldl
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 OESCRIBE WORK
Constrnct a 9'6" x 8'3" Addition to house
9 CHANGE OP USE FROM TO
STIPULATIONS provide vapor barrier on walls and ceiling. Insulate •walls with
minimum R-11 insulation and ceiling area to R-22 min�.mum. Provide 22" x 30" acc s
attic area.
����
� d�K pii looit utii�ies
5� �� EF�ATE PERlY1J-T3 �R�t,�VtREC� '�i�R 4�1iRiNG, �� • ftECTRfC • GAS Ete.
�EATrNG, �rulMB!!� ANO S�6iv�, REQUIR�D 6Y IA�N
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. �OOC� Fr�e
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTEH WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION STALIS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPIIED.
WITH WHETHER SPECIfIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1 � 762 $• 88
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMiT FEE SAC CHARGE
PFiOVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 8� OO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $
PLAN CHECKFEE TOTALFEE
�8.88
Si IJATUREOFCONTRAC O THORIZy° AGENT IDATEI WHEN P OPERLY VALIDATED THIS IS YOUR PERMIT
- �;t�,Le�.c aE 9 �� - l'7 ��l � �cl�� `� �� -h rl
SIGNA E OF OWNEii IIF OWNEp BUILDERI IDATEI � BLDG INSP ---�� �-
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s to
CITY U(= FRIllLEY
APPLICATIOtJ FOR RESID�.r�T1AL Bu1LD1NG PERC�IITs
iNEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
owi�ER: ���R�'/o r� Q �E�L�9nL.D BUILD�R: _�}m �,
Address: ��6 Cyiv�✓n�eC /� NE. Address: .
F�, a�� y M iNN srs�3�, .
��71 . Q �� Te 1. No . :
No. : �8l( Street : �NAi✓i✓� C �. �E
LOT : �� BLOCK: "- ADDITION :/�iPO o K V i e U/ /9�v,�Q�v
CORNER LOT: INSIDE LOT: _�� SLTBACK: SIDEYARDS:
Applicant attach to this form �ao Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING ��
To Be Used As:
�9aai iai✓ To , „ ' . _ •, i
Nou,SE Front: 9� ( Depth: 8 t�3 Height: ��
Square Feet: �p� � Cubic Feet: 9 7 � ✓�.�-�• �•
Fron t :
Depth:
He ig ht :
Square Feet: Cubic Feet:
/OG
Type.of .C.�nstruction: ,Lc�do� FR�ME Estimated Cost: $ \
Zb Be Compieted: � y�. /�G 2�$
— Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance �vith the City of
Fridley Ordinances and rulings of the Department of Buildings,'ann hereby
declares that all the facts and representations stated in this application
are true and correct. See reverse side r additional i fozmation.
DATE: 7`//' �'� SIGNATURE: a�-f-c� �t��+-�-a� �/
Stipulations : 9• �� B� Z b =��i'j� �
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BUILDIWG PCRt�1IT FE� �CNEDULE
SECTION, ?.. The Inspector of Builuings sha]_1, heforc i,suing ��cr.mits for thc crection
oi any bui.ldiny or �trucL-ure, ur for ��ny adciiti.on to •ar�y c�xisting buildiny �r. structure,
or for any alteration or repairs Lo any er,isL-it�g building or structure, upon ap��lication
therefore, require the paymenF by tt�e anplicant ior such permit of fees to Lhe amount
her�in below set forth and in the manner herein provided L-o-wit:
NL•'W CONSTRUCTIOII: Sinqle-�amily Homes and GaYages: $4.00/1,000 cubic feet.
PLAN CIiL•'CK: 25 percent of �iuilding permit fee.
DRIV�WAY DLYI2�S5IOP�: (Concrete Curb Streets Only)
� AlL-ernate A: I2emoval and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x 511.75
Alternate B: Itemoval and replacement of concrete curb and
gutter.and install a 3 foot wide approach with
6 inch depth; L`riveway width plus 6 feet x$15.40
ADDI T IONAL I NFOR�IAT I ON
For the purpuse of computing fees for building permits, the cubical contents of any
building �r. addition, is determined by multiplying :he ground area covered from a
point siY (G) ir_ches below the floor line of the baseinent or the cellar to the
average heights of the upper surf ace or to the average height of the roof surface
of the main gable of a pitched roof.
For repairs or alterati.ons to an existing structure, the fee shall be at the rate
of $3.00 Laer each five hundred dollars ($500.00) or fraction thereof in the cost
of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be less
than $7.50 plus $.50 state surcharge.
VERIFICATIOV OF FOUNDATIOIV
NOTE: Pern�its �or construction will be issued a minimum of 24 hours from the time
of applica�ion to allow for proper review of the proposed structure and of the
construction site.
A Certificate of Sunrey of the lot, showinc� the location of the foundation once it
has been constructed will be required before proceedirg with the framing.
CCi2TIFICATE OF OCCUPANCY
A�plication for a Certificate of Occupancy shall be made ten (1G) days prior to the
use or accupancy of any structure for which a building permit has been issued; and
s�id structure shall not be used or occupied un�il a Certificate of Occupancy has
been issued.
.
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g X�0 CCON�R�% �pot �NG S
� �` Mr,ve �Rp�� -ro ��Rr
a x $ .�o��i �l� '` v.c.
i x 3 �,cl o o� �,4 � C-,
� x� x 3/� i. G. C-� r u.� D.�-
�,x j� - �(o �� O. C . �`Tu.Dt�s
� = aZ X / � s N � R s . �,E �,c�iNG
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'1 �. � � x P� y li/oo�
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b S I 6- C� N/� NN� L�'�. N- E,
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$ -. 3
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STATE OF MiNNESOTA DEPARTlENT OF HEALTH
� ABANDONED IIELL RECORD
�. �p�T�p� p� ��� ' MiNNESOTA UNiQUE MELL N0.
(le�ve Olank tf not known)
COUnty Nte!
Tamship Ma�e Tovns�lp Mw�Oer Range Nu�Eer Sectton Na: Frutton 1. YELL DEPTM (ce�pleted) D�te sealed
�j E 4 k of 4
3� 5' °' /�'v ,t. s_ � �-�' f
MunN u1 Street 4dOress +n0 5. ORILLIN6 METXOD (tf knwn)
Inten�ctton � �.L+ble tool � 14rerse 7'[] Dr/ren If� Du9
'. ip Nol lov Ilod 50 A1r � lored 13[]
�] aos,�y 6p a.ec.a S� Pover ���
sAor ee n or .e11 .
(in t�etlon yr10 �tt� Sketth wp of rell loution 6. 0lSTRUCTIONS
N w�n oescrvec.a p r.s �Mo
_►._ ,; oE:e�acHoe: n.or.a p re: p Mo If elssrvcstees o.nnoc e.
. . ' � � rwored. WnNCt IOM
, � , _f. . - E e.r°n �.a�.9.
M .
� � , � ). USE
- - <'� ; w. 1�Do�estle Q Ibnttortn9 � Me�t loov
. . . , � 2[] ]rriqatlon 5Q hblte � Ineustry
..�.. .. _.�......
3p r�:t r.ii ep �m+�+w> >� eo�e��++t
� 1 SL' 7[] A1r Conditloning 11�
2. � ER,C�WtiiE � . _ . - - iattf ng Adtlttss f i df fitrrrtt :trtn---- — - - - 8: G15iN� ) - - �-- --- — — � — � — -- —
property iddnss lndtuted �bove 1�,61�ck f0 Tlw+ded 7[]
2� 6lir. 5[] Yelded
30 Plasttc � St�lniess Ste�l
lUIRDNE55 OF _�_ �� tp 3 �� it.
7. FORIYITIOM LOG COLOR fOR►NT10N FROM TO
1f not knovn, tndlute fo�atlon 1oy fro� new well or narby vell. 1n. to ft.
9. SCREEN
� Streened vell f�,y��t. W ��t.
(If knovn)
. p ov� eoi� rw. _ rs. u_ rs.
10. STATIC MATER LEYEL
,S`T/ ft.�Wlor ❑�bovt
laM surt�ce D�u Me�sund
11. YELLNEAD COIY�ETI011
1[] Ntless IW�pter � Found Wrted
��se�ent effset � .
_ . � Matl Ott
i, REINRlCS. EIEYATION, SOURCE Of OATA - CASIMGS REMOYED, GlSiN6S FERFORATED, ETC.
12. 6110UTIN6 1NFORIi�T10N ,
1��Ne�t Cawnt 2� tentonite �
6rout wt�H�1 �3-- rro�✓,�jg[o� tc. cu. ras
' 1�. NEAREST SOURCES OF CQIfTANINATION �,
�� feet �v dtnctton typt
Mell dlstnfccttd before sealingT ❑ Yes
1�. PUNP p ae.ovea �-Not Vnsent
TYV�: 1� Subrrstble � L.S. Tu�llne � Ikctproc�tfnq
2j] Jet Q Centrtfuyal �
15. E%ISTIMG IfELLi (►l�+s� sketcD lxatfons of aeandoned �nd
�cNr� retlf tn nMrkt fKtten Or on lack,)
Othe� unused wll(s) on Drooertrt ❑ Yes �No
. Abandoned: [] Per�anent ❑ Ta�por�ry ❑ Not se�led
ll, vATER vEIL CONTRACTORS CERTIFICATtOK
TM s welt waf scated under ey Jurtsdlctton and tAtt�report
it true to tAe st of �y knovledqe and Oe11ef.
�� � `
ltcensee Wslmss Na�^ . Uce s� No.
b�
Addreff
Stqned �' Date �
ac.
FiIC1At It�+tN00MfD YEI� IIECORD (M+y E� ufeA !or Property Tnntier) N o rill�
Z�CRTi1fSt tlll NSld DIQD . •
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SUB�ECT
c�ty of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
� �
� �• COMMUNITY DEVELOPMENT DIV.
� � �: ------�
r � � PROTECTIVE INSPECTION SEC.
� � �"'t � CITY HALL fRIDLE� 55432 NUMBER Aev
�""�' ,'' 612-571-3450 910-Ft5
108 ADDRESS 6816 Channel Road NE
1 LEGAL LOT NO. BLOCK TRACT OH ADDITION
DESCR. 21 Brookview Addition
2 PHOPERTY OWNER MAIL ADDRESS
Troy Hoff 6816 Channel Road NE
3 CONTRACTOR MAILADDRESS
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAII ADDRESS
6 USE OF BUILDING
Residential
7 CIASS OF WORK
X NEW ❑ ADOITION ❑ ALTERATION
8 DESCRIBE WORK
Construct a 12' x 20' Shed
9 CHANGE OF USE FROM TO
DATE VAGE OF
11/22/96 / /
ZIP
ZIP
�PERMIT NO.
?�a�5
_�
RECEIPT NO.
��ll
nPPROVEO Bv
SEEATTACHED
SHEET
PHONE
571-3642
PHONE UCENSENO
PHONE LICENSE NO.
PNONE LICENSE NO.
❑ REPAIR O MOVE � REMOVE
STIPULATIONS
Shed constructed before obtaining permit.
TYPE OFCONST. OCCUPA
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULI AND VOID IF WORK OR CONSTRUCTION ZpNING SO. fT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOFi A PERIOD OF 120 OAVS AT
ANY TIME AFTER WOHK IS COMMENCED. NO. DWLG. UNITS
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINEO THIS APPLICATION 1 STALLS
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yAIUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �Z�OOO
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTMER STATE OR LOCAL lAW REGUTATING CON-
STRUCTION OR THE PERFORMANCE OF, C�ONSTRUCTION. �GZ. ZS IF �GI.. ZS
RACTOR OR AU�FHORIZED AGENT IDATEi `
�
a �IF OWNEA BU�LDEp� iDATE�
NCYGROUP OCCUPANCV�OAD
CU. FT.
OfFSTREET PARKING
IGARAGES
�1.0�
C CHARGE
Fire SC $2.00
iTAL FEE
$127.50
THIS IS V/QU-R PERMIT
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ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMII,Y AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 3/1/96
ConstructionAddress: /� �/(,; � � �� � � j �j
Legal Description: _ ��.,, a
Owner Name & Address: � � rc� 1����� l C� C l�� r� re 1�2 1, Tel. #� 7{ - 3� � z
Contractor: MN LICFNSE #
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTI�R:
Attach to this application, a Certificate of Sbrvey of the
lot, with the proposed construcdon drawn on it to scale.
DESCRIPTION OF IlIZPROVEMENT
I-ength � Width � z Height , L
Length Width Height
Length Width Hgt/Ground
Tel. #
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [] Inside Lot [v]� Ft. Yd Setback Side Yard Setbacks
Type of Construction: �� �� � Estimated Cost: $ Z�.�
Approx. Completion Date: �o,,,.�,
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �\- ,��, � (� APPLICANT: � _ ,,�,-'�,, � Tel. # � 7 / - �!� �i 7 _
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Gharge
TOTAL
�TIPULATIONS:
�.,? ,�� CITY USE ONLY
,
$ ;o �- �:� Fe� Schedule on Reverse Side
$ � LJ�� .001 of Permit Valuation (1/lOth%)
$ /�G'C> $.50/$1,000 Valuation
$ $900 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Al� "B" Above
$ $450.00 Conservarion Plan Review
$ Fee �k:temnined by Engineering
$ Agreement Necessary [ ) Not Necessary [ )
$ �% 5�'
BUII.,DING PERMIT 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 building or
structure, upon application therefore, require the payment by the applicaat 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 $1,000,00p
FEES
$21 (Minimum Fee is $21 plus surchaige)
$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,ppp
$349.75 for fust $25,000 plus $9.00 for each additional$1,000
or fraction thereof, to and including $SO,ppp
$574.75 for fust $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 inciuding $Spp,ppp
$2887.25 for the first $500,000 pius $q..25 for each additional
$1,000 or fraction thereof, to and including $1,UQ0,000
$1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 for each, additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete C�.rb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "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
Permits 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 const�uction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has be�n constructed
will be required before proceeding with the framing.
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LiNO SURVEYOR_
RtGIST6RiD UMDiR LAWS OF 9TAYE OP MINNElfOTA
LlCENS[D BY OROINI:NCE O� CITY OF MINNEAT0�19
3616 tAST 55tri STREE7 PA. 4-4681
�unc�por'S �ertifirstr
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( H�R°_HY CERTIFY THAT THE A80VE IS A TRUE AND CORAECT R.1T OF A SItRVEY Of
_ . J H L Y :7 � � �i .� �u���+ � ♦
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�.S Sli4Y£Y�O 8Y 4[ i.`115:_._. ���--"DAY OF___.v �..L a.A.D.-- _ •
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� F. C. J.�lCK50N. MINN[SOTA (i�EGIlTRwT10N, tVO. 3600
� • e !S �
suerecr P IT NO.
City of Fridley 2 6 9 9 2
' , AT THE TOP OF TME TWINS g � i L D I N G P E R M I T RE O.
r
� � COMMUNITY DEVELOPMENT DIV. ���y�
� PROTECTIVE INSPECTION SEC. y
� _
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� /'�'1 � CITY HALL FRIDIEY SS132 NUMBER REV DATE PAGE OF AVPqOVED BY
�""'� � �'� 612-571-3450 9t0-F15 8/5/98 � /
JOB ADDRESS
6816 Channel Rd
1 LEGAL LOT NO. BLOCK TRACT OF ADDITION SEE ATTACHEO
oesca. 21 Brookview Addition SHEET
2 PROPEF;TY OWNER MAIL ADORESS ZIP PHONE
3 CONTRACTOR MAIL ADDRESS 21P PHONE IICENSE NO.
Donner Const Co 6305 Camden ��312 Brookl n Center 4 6- 7 69 4
1 ARCHITECT OR DESICaNER MAIL ADDRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUIIDING
Residential
7 CLASS Of WORK
� NEW O AD�ITION 0 ALTERATION Xj[ REPAIR O MOVE O REMOVE
8 OESCRIBE WOpK
Reroof 22 S Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
TYPE Of CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATINCa,
VENTILATING Oii AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID If WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCEO WITHIN 80 OAYS, OR If CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTFEE7 PARKING
I HEREBV CERTIFV THAT I HAVE READ ANO EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW TME SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS Of LAWS VALUATION SUiiTAX
AN� OROINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIEO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 39H6 �.92
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL TME pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTMER STATE OR LOCAL LA REGULATING CON-
S RUCTION O TNE P FOF NCE OF CONSTRU �ow. 59..5� Fire .SCi �1.83
� PLAN CHECK FEE TO FEE
icens $5.00 .25
SIGNATUAE OF CON'PACTOA OA AUTMOp�2E0 AGENT IDATEI N OP LIpA TNIS IS UR PEFMI
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SiGNATUAEOFOWNEQdfOWNEABU�IDEAi �DATE� BL �NSP pFT
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
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ConstructionAddress: � // �,��/��
Legal Description:
Owner Name & Address: � �e �/ a N� �0 �'`�-- Tel. #
Contractor: ��(� p /� �� ,�o ��'_�°��r MN LICENSE # � �! � �i
Address: � 3 D� � P��� Tel. #���s 3��
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
GARAGE AREA:
DECB AREA:
OT'HER:
DESCRIPTION OF IlVIPROVEMENT
Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
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Construction Type: �p d� vGIG' Estimated Cost: $ � 7��
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$.
_$•
DAT'E: � �� � APPLICANT: Tel. # !�� �� �� 3`�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �� �
$ 1��3
� �i2
$
$ �. j �v
$
$
$
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1 / l Oth %)
$.50/$1,000 Valuation
$1000 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 [ ]
$ �ZS
-� � � Y
BUII.DING PERMIT FEE SCHEDULE
The Chief Building O�cial 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 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 addidonal $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)
Altemate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "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 $15.75.
VERIFICATION OF FOUNDATION
Pemuts for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
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LAPIiD SURYEYOR
RtG137iRED UNDER LAWS OP STATE OR MINNE$OTA
L!C=NSlG OY CROItiANC[ pi� ClTY OR MlMNlAi�pl,la F
3615 EAST 66TM STREtT PA. 446Bt
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I MERE9Y C£RTIFY TNAT TN[ ABOVE IB A TRUE AND CORRGCT PLAT OR A SURYEY OF _
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AS SURVEYcD- BY ME TH�5--23.=�--o,,Y OF__..v�i'�.a---A.D.--1��1�-�- �% ,;' •.� ` �� �.
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F. C. J,4CKSON. M�tvHESpT���G�s7stwT�on, NO. 350�
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