AF - 38603BUII.IDING PERMIT
Village of Fridley, Minn.
Date !•"':�'�.`.�.'��.'.��� ..........................
Owner � ��» �,.�•� . . . �-r : . .�.'�.'� ; !�:t�`°`t°� .�: �':'. . . .
N° 2548
Builder . ���'�� ;�;t..;� . . . . . . . . . . . . . . . . . . . . . . . .
Address M`�.�3�' . ._,��� .�'-.�:°:�'. . . . !�°: i�.:`�. . . . . . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LOCAT(ON OF BUlLDING
�,��; r�,�"� .
No. . � ��,�F. .. . . . Street . �.���:+�.�1?��. �.�:°'. . : i�� . . . Part of Lot . . . . . . . . . . . . . . .. . . . . . . .
Loi . . . ..�.��. . . . . .. . Block . . . . �'. . . . . . . . . Addition or Sub-Division ��:����.���`�;*,', ,�, ,�, . . ;""��s'"'�"�`r�`'3
Corner Lot ............ Inside Lot ...:�::...... Setback a��~'��":�`� Sideyard �e��.���'`.'�: � ..............
To be Used as:
_ ��s��� ���. . .
DES�CR[PTION OF BUILDiNG
Front . e�.�. . . Depth ,�r:�: . . Height ,��„��: . .
� .................... Front ........ Depth ........ Height .........
Type of Construction „�"js�;�a:.�-c,&' Est Cost .":`:��'��. ".�!�...��. �....
Sq. Ft. �`.�.+� . Cu. Ft. . . . . . . . .
Sq. Ft. ........ Cu. Ft. ........
To be Completed ��. . �.;:'�'�:��d�a;'
In consideration of the issuance to me of a perxnit 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 all provisions of
ordinances of the village of F'ridley.
� consideration of the payxnent of a fee of $. .,�,�� ., permit is hereby granted to �r�. .�'u; :* :....
�'s^"'.. �.�.�!�.,��;�...... to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and worlanen, 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 ihe village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. �_ ,,�.
�
NOTICE:
�t'.�,����".�::� �;%°... Building Inspector
This permit does not cover the construction, installation or alteration for wi�ing, piumbing, gas heattng,
sewer or water. Be sure to see the guilding Inspector for separate permits for thesa items.
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City of Fridley, Minn.
B�.TII�DII�G PERMIT
.... �^.g%� .................
.����i. . . � . � !. . . . . . .
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N° 3214
su�a� . ��l�; ;ZZ� . . . . . . . . . . . . . . . . . . . . . . . .
Address .................................
LOCATIO�V OF BUILDING
t �
No. v .�.!!a. Street ... . . . . . .. ................ P of Lot ........... .......
Lot . . �� . . . . . Btock . . . . . . y Addition or Sub-Di� . . . . . . . . . . .• • . . .
_ �
,
Crn�er Lot . . . . . . . . . Inside Lot . . . . . . . . . deyard . � t�. %�,��� •.
.. . ... Setback . ........ Si ..� ��.
DESCRtPTION OF BUILD[NG
be Used as:
. . . ..'.. . Front . . /. b. . DePtl�► • �!.� Height . .. . � . Sq. Ft. J "� '?� Cu. Fk ... .. .. .
. .. . . . . . . .. .. .. .. . . . Frorrt . . . . . . . . Depth . .. .. . . . eight o a. . . . Sq. Ft. . . . .. . Gti. Ft.
Type o! Construction . ��Al�� . . . . Fst Cost. . . . . �+�% Q . �' . . . To be Completed . � . iiyl.l� .. . . . . . .
���' � �, - . .
.
� �. ' . , un-�.�. `�`.�.' �`,c..�! ,
....--�..�
� iG `' ��,
�.�C�.�..�P
.
In consideratia► of L1ie issuance to me of a permit to construct the building desribed above, I agree to do
the proposed work in aceordartce with the descrfption above set forth and in compliance with all rovi�o,ns eyf
ordinances of the city of Fridley.
• ��y��.��• °,�•�j• . . . . . . . . . . . .
O � .�In consideration of the payment of a fee o! ;. .... `�.. ., permit is hereby granted to ..... .. �
. . . .. . . .. .. . . :. . . . . . .. . . . to construct the building or addition as described above. This permit is granted upon
the express oonditfon that the person to wha� it ia gi�anted and 1�is agents, employees and worluaen, in all wrork
done in, around and upon said building, or any part thereof, shall c�onform in all respects to the ordinant�s of
FridleY, Minnesota regarding location, constructlon, alteration, maintenance, repair and moving of �ildings with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
��!.�.� B� �
NOTICE:
This permit does not oove� the constnictlon, Insta�tattion or alteration io� wi�in�, pinn�
�ewe� o� wste�. Be wro to ses the Bull�ind Inspeo�to� fo� �epan�te perm]b for tlas� ttsms„
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City of Fridle� �
AT TME TOP Of TME TWINS
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' ' COMMUl�11TY QEVElOPN1ENT OIV.
r � v '� PHOTECTIVE INSPECTION SEC.
� %� �nd
i ---. ��'���C}�Y'�'A�� fRIDLE� SS�32
L '' 612-571-3450
�oe AooAESs
5120 Clearview St
t IEGAL �OT NO. BLOCK TRAC'
DESCR. 19 6 Car
2 PfiOPERTY OWNER MAIL AOORES$
� ARCMITECT OR DESIGNER MAIL AOORESS
5 ENGINEER MAII ADDRESS
6 USE OF BUIl01NG
Residential
7 CLASS OF WORK
� NEW O ADDITION O ALTERATION � REPAIR O MOVE O REMOVE
8 OESCRIBE WORK
Reroof house and �araQe 119 Sal
sue�ecr � � � � � � r V.
BU ILDIN� PERMIT � 8 � 6 3
�760
NUMlER � AEV OATB VAGE Of A►PROVED !Y
s�aF�s / /
OR ApO1TION SEE ATTACMEO
�.,,, ► � e....,.,,; .- �a..,,,..- SFIEET
ZIP
ZIP
.J / 1 �
vMONe
PHONE
IICENSE NO
LICENSE NO.
LICENSE NO
9 CHANGEOFUSEFROM TO
STiPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE RECUIRED FOR EIECTRICAL, PLUMBING. HEATING. ��rC �� �vn��. oGGUPANC
VENTI�ATING OR AIq CONOITIONING
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION IONING SO. FT
AUTHORIZEO IS NOT COMMENCED Vy1THIN 60 DAYS. OR IF CONS7RUCTION
OA WORK IS SUSPENOEO Oii ABANQONEO fOR A PER100 OF 12Q OAY$ AJ �
ANY 71ME AfTEF WORK IS COMMENCED. ' NO DWLG. UNITS
I MEREBV CERTIFV THA7 I MAVE REAO ANp EXAMIN�D THIS APPLICA7IQN S7ALL5
AND KNOW THE SAME TO BE TAUE AND CORRECT. ALL PAOWSIQNS df �MW$ yA�UATION
ANO ORDINANCES GOVERNING THIS TVPE OF WORK WIL6 BE CpMP41E0
WITM WMETHER SPECIFIED HEREIN Ofi NOT. TME GRANTING OF A PERMIT �gfl $162H
OOES NOT PRESUME TO GIVE AUTMORI7V TO VIOLATE OR CANCEL 7NE pEpMIT FEE
PROVISIONS Of ANV OTMER STATE OR IOCA� LAW REGUTATING CON- -
STRUCTION OF TNE PERfORMANCE OF CONSTRUCTION �S�F.00
p P�AN CMECK fEE
\ T� � ��-0$�14
S�GNATUAEO�CONC CTOpOpAUT«OaijEDAGENT �O�TE� �
EN OP p AUD
$�GN�TUAE O� OWNEp��F QWNEp BU�LDEAi �♦fE� ' � a� _...ee
UP OCCUPANCVLOAO
CU FT_
fSTREET PARKING
IGAiiAGES
�.81
iAC CMARI
Fire
'OTA� E
$5 .44
1.63
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NEW
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
�, Pa g�6�
ConstructionAddress: 5� a n C,� eQ Y` V t� W ��'
Legal Description: _ _ � p p �
Owner Name & Address: � rP SG� Qy �� Tel. #�)1 � d� d
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
I.ength 4 U
Length a�
Length
Tel. #
Width �_ Height Sq. Ft. l q�'a
Width �� Height � Sq. Ft. �! y a
Width Hgt/Ground Sq. Ft.
�(I'sa -- ,/_ , �
Construction Type: rU ��� r�� ��, Estimated Cost: $ a� v0 . 0 O
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: 10 -C� 8-�i '8 APPLICANT: `�s�n,t,g,e� P� Tel. # S l l 7 d 8 a
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
���� �
� �
$ ��
$ /,� 3
$ �l
$
$
$
$
$
$
$�'�y.
CITY USE ONLY
Fee Schedule on Reverse Side
.00l of Permit Valuation (1/lOth%)
$.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 [ ]
�
�. • �
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 applicant for such permit of fees to the amount
herein below set forth and in the �anner 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 iirst $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)
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 $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
City of Fridley
AT THE TOP OF THE TWINS
f
i L
� ; V ����� COMMUNITY OEVELOPMENT OIV.
r � � PROTECTIVE INSPECTION SEC.
� i ,
� �"'1 � CITV MALL FRIDIE� 551�2
�""� � �'' 612-571-3450
sue�cci
6UILDING PERMIT
NUMlEF NEV O�TE vAGE O�
s�aF�s 11/13/00 � �
i55�
RECEIPT NO.
7/D �
•PVROVEO Br
�oe �ooaess 5120 Clearview Street NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACNED
DESCR. 19 6 Carlson's Summit Manor South Addn SHEET
2 PiiOPERTY OWNER MAIL ADORE55 21P PMONE
Theresa Pyka 5120 Clearview Street NE 763-571-7082
3 CONTqACTOR MAIL ADORESS Z�P PMONE IICENSE NO
K-Designers 3810 W Hwy 13, Burnsville, MN 55337 952-894-3600 20138685
1 ARCMITECT OR OESIGNER MAIL AOORESS ZIP PMONE LICENSE NO.
5 ENGINEER
B USE OF BUILDING
Residential
7 CLASS OF WORK
MAIL
❑ NEW O AODITION O ALTERATION
B DESCRIBE WORK
Replace wir.dows
9 CHANGE OF USE fROM
TO
ZIF PHONE LICENSE NO
�7 REPAIR O MOVE O REMOVE
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the
dwellir.g per Section 310.9.1.2 of the 1997 Uniform Building Code.
SEPARATE PERMITS ARE FiEGUIqED FOR ELECTRICAL. PLUMBING, NEATING. ' rrc vr �,v�:
VENTI�ATING OR AIq CONOITIONING.
TMIS PERMIT BECOMES NULL AND VOID If WORK Ofi CONS7RUCTION 20NING
AUTHORIZE� IS NOT COMMENCEO WITMIN 60 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO fOii A PERIOD Of 1T0 DAYS AT
ANV 71ME AFTER WORK IS COMMENCEO. NO DWLG. l
1 MEREBV CERTIFV TMAT 1 HAVE READ ANO EXAMINEO THIS APP�ICA710N 1
ANO KNOW TME SAME 70 BE TRUE ANO CORRECT. ALL PROVISION$ Of LAWS yALUATION
AND ORpINANGES GOVERNING THIS TVPE OF WOqK WILL BE COMPLIED
WITN WHETMER SPECIFIEO NEREIN Oii NOT. TME GRANTING OF A PERMIT �10,951
DOES NpT PRESUME TO GIVE AUTMOAITV 70 VIOIATE OR CANCEL TME pEpMtT FEE
PROVISIONS OF ANY OTMER STATE OR �OCA� LAW REGUTATING CON-
STqUCTI N OR THE P fOfiMANCE OF CONSTRUCTION $195.ZS
'� � � PUN CHECK I
c 3_ �av
�icen
. . �GN�tUAE �CON'A�(;TOpOA�UTMOp�2EO�GENT 10ATf� , H
� ... . _
�rGGUrwNG� GiiOUP OCCUPANCV LOAO
SO. FT CU fT.
OffSTREE7 PARKING
STALLS G/►RAGES
SURTAX
$5.48
SAC CMARGE
Fire SC $10.95
Tn� FEE
$.� $216.68
V
r�n
T
N� � � Effective 1/1/2000
ADDN [] CITY OF FRIDLEY (763) 572-3604 Bldg insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION � a.l %/O�'
Construction Address: ��(aU � ��✓� �� �� ��
Legal Description:
Owner Name & Address: "�l�S� Py �a Tel. # 7 G�'� - S 7I '7��
Contractor: 1� "�eS, ti,n eJ5 MN LICENSE # a d(��s C�� S
Address: 3 is I c� cJ �,2 �JM SU ��\c ✓v1;r� S S 3 3 7 Tel. #�' S�a -�5�1 ��(o 00
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Wdth HgUGround Sq. Ft.
Construction Type: 1����y ��o�A�� c��.,� (.�%��%.��.J�stimated Cost: $� 10� 9S (. 2..�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: ��3 �c��_ APPUCANT: �'1'`"`- Tel. # Q� a- ���I "3 C� OU
CITY USE ONLY - Call (763) 572-3604 for Pertnit Fees if mailing in application
Permit Fee $ 1��� �S�-fee Schedule on Reverse Side
Fire Surcharge $ %-`�Sw .001 of Permit Valuation (1/10th%)
State Surcharge $ ��'�o° $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
�
�r
$1100 per SAC Unit
$ �- � v $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$,
$.
$ �1�.6�j
.Fee Determined by Engineering
Agreement Necessary ( ] Not Necessary [ ]
�,. _ f -
BUII�DING PERMIT FEE SCHFDULE
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 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
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each addirional $1,000
or fracdon thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each 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 G�rb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Altemate "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 $23.25.
VERIFICATION OF FOUNDATION
Pemuts for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv
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NOIIV�I�Ib3A 2lIV NOI1Sf18W0� aNV 2101�3NN0� 1N3/� 1N3A NOWWO�
sue�cer IT N .
c�ty of Fr�a��y 3 � 805
AT TME TOP OF THE TW�NS � u I L D I i \� P E R M I T
r
; � ` RECEIPT NO.
� • COMMU�IITY OEVELOPNIENT OIV.
r � V � � PROTECTIVE INSPECTION SEC. ��������
� .
l.--• w;�'��,•� CITY MA�L FF110LE� ��JZ NUMlER pEV OATE PAGE Of APPROVED 0�
L J� 612-57�-3a60 s�aF�s 5/8/�1 / /
JOB ADDRESS 5120 Clearview Street NE
t LEGAL LOT NO. BLOCK TiiACT OR A�OITION SEE ATTACMEO
oescR. 19 6 Carlson's Summit Manor South Addition s►+eer
2 PROPERTV OWNEp MAIL AOpRQS$ 21P PMONE
Theresa Pyka 5120 Clearview Street NE 763-571-7082
3 CON7iiACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Same
a ARCMITECT OR OESIGNER MAIL AGORESS ZIP PMONE LICENSE NO.
5 ENGINEER MAllAODiiESS 21P PMONE LICENSENO
8 USE OF BUIlO1NG
Residential
7 CIASS OF WORK �
O NEW O AO�ITION ❑ ALTERATION � REPAIR ❑ MOVE : O REMOVE
8 DESCRIBE WORK
Reside House
9 CHANGE OF USE FROM TO
STIPUTATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather
resistive barrier be placed over exterior sheathing to protect the interior
wall covering. Exceptions for this provision would be if sheathing is ar
approved weatherproof panel or when the siding is an approved weather
barrier. Vinyl siding is not a weatherproof covering unless the manufacturer
states this in their application guidelines. Call for inspection of wrap
before covering.
SEPARATE PERMITS ARE REOUIFiEO FOR EIECTRICAL, PIUMBING. HEATIN,Ca, TYP C1F CONST. OCCUPANCY GROUP OCCUPANCV LOAp
VEN?ILATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NULL ANO VOIO If WORK OR CONSTRUGTION ZpNING SO. FT CU �T
AUTHORI2EO IS NOT COMMENGED Y�!ITHIN 60 DAYS. Oq IF CONSTRUCTION �
OR WORK IS SUSPENDED Oli A9ANQON�O FOR A PER100 OF 1iQ OAYS A�
ANY TIME AF7ER WOpK IS COMMENCEO. ' NO OWLG. UNI75 OFfSTREET PARKING
I HEREBY CERTIfV TMAT I MAYE READ ANO ExAMIN�O T►11S APP�,ICA710N 1 STA��S GARAGES
ANO KNOW TME SAME TO BE TFIUE AND COPRECT. ALl PROVISIQNS Of LAWS yA�UATION SUtiTAX
ANO ORDINANCES GOVERNING TMIS 7VPE OF WQRK WI�L �� CpMP41E0
WITH WHETMER SPECIFIED MEREIN OR NOT. TME GRANTING OF A PERMIT �2�000 �L.00
OOES NOT PRESUME TO GIVE AUTMOAITY 70 ViOIATE Op CAMCEL THE pEpMIT fEE SAC CMAFGE
PROVISIONS OF ANY OTNER STATE Oii LOCAL lAW REGULATING coN• $69 � 2S Fire SG �p2 .00
STRUCTION OR TNE PERfORMANCE OF CONSTRUCTION
PIAN CNECK f EE TOTA� f E
��2. 5
S�GN�TUpEO�CONCi7�(;TOpON�UTMOA4E0AGENT iDAiE� MEN RO.E ALIOATEO TMI IS VOUA PE T
c ��
� J � Q � j' � �4 �
$�GN�TUAE O� OWNE i�� �W Bu��OEp� �� i0 fE� ' �µ50 � ' �� � liff
NEW [j
ADDN []
ALTER [ ]
Effective 1 /1 /2001
CITY OF FRIDLEY (763) 572-3604 Bidg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: _� I d U C�Y Vl� �> s�
Legai Description: �J ► C� [ r1 q
Owner Name 8� Address: �'1,� Y�50� Qy ��. Tel. # 7� �, S �% 70 ��
Contractor: I'1'l y S e l-� MN LICENSE #
Address: _ � � 0�2 0�e01 r V l 1° � Sfi Tei. #'? b� J � 1 % �� �--
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft
Construction Type: ��� Y1 rA' � L° S 1�C,° Estimated Cost: $ 02 p C� p.°°
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: J$ 0( APPLICANT: Tel. #
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
. n --
$ 7,�� Fee Schedule on Reverse Side
$ �`�� �� .001 of Permit Valuation (1/10th%)
$� �_�(� $.50/$1,000 Valuation
$ $1150 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 [ ]
$ `� ��
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 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
$23.50
$23.50 for %rst $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each 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 install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Pernuts 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. New Houses Onlv
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