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AF - 43265�, �� City of Fridley, Minn. BUILDING PERMIT ��: august 9, 1965 �Qd�� N� �334 DOROTHY SHAFFER Same Owaer: Builder p� 181 Crown. Road A� ` LFridley, Minnesota LOCATION OF BUILDING No. 181 s�t Crown Road P� ��t _ I.ot Sl�k Addition or Sub-Divisi� Coraer Lot Inaide Lot Setback Sideyard 3e�ver IIevation � To be Used as: Front Front 7j►�e of Constzuctton Fo�mdation IIevation DESCRIPTION OF BUILDING Depth Height Depth I�eight r � � $600.00 Sq. F't. Cu. Ft 3q. Ft Cu. F� To be Completed Rebuild Gaxage • Due to storm dama.ge In constderatlon oP the issuanae to me of a permit to construct the bwtldiug described aimve I agr+ee to do the proposed work 9n accwr�dance with the d�scrlplion above set Porth and in compliance� th a'll provlaions of ordinaaces oP the city oP Fridley. �' �� - In camasideration of the paqmeat of a fee of $ 5.00 ��t is hereby granted to DOROTHYcxr �R to construct the buflcling or addition as described above. This �ermit fa granted upon the express condition that the pereon to whom it ia granted and his agents, employeea snd worlQnen, in all work done in, around end upon said building, or any thereof, ahall conform fn all reapects to the ordinance� of Fridley� Minnesota r�:gardisg �� ca �u �al t � � � ��ir� � �g�o�f� �din�Sds wi�� dty ]imiffi e� this �� 7 � -1 � �r�� •. �,��.s� . NOTIC� TI� permB doa rto1 cevar �6s coestra�, t�iall�oe hr �r6deW Plumble9. sn MaNng, arra e� wa�ar. Be suro to ss� tM Butldiog le�e�sr fer apuaf� p�s Po� fha� h�nu. APP'LYCATION FOR BUlLDING PBRNBT ; CITX OF FRIDLL�Y, ,MINNESOTA OWNER' S NAME �e .e'�L,� BtJILD�R. . . . ; ADDRESS C� ADDRE5S, , , LOCATIOAT•OF $UILDING . . N0. STREET � PART OF LOT LOT BLOCK ADDITION OR SIIBDiVISION CORNER LOT TNSIDE LO'� SETBACK SIDE-YARD � SEWER ELEVATION FOUPDAT�ON ELEVATIUA � Applicant attach to this form Two CeYtificatea of Survey of Lot and propoaed building location drawn on theae Certificates. �' • �� :� � � � � i , � y ` / � � � , �.,/ / .a , i . .J -. . � / Front Depth Height Sq. Ft. Cu. Ft. � Front Depth �� Height� ' Sq. Ft. 'Cu. Ft., Type of Construction Estimated Co�t�G., f p d' . To be completed � The undersigaed hereby makea application for a permtt'for the work herein specified, agreeing to do all work in strict accordance with tt�e City of Fridley Ordinances and ruliags of_the Departmeat of Buildinge, and,hereby declare� that a11 the facts and repr�sentations�s�ated in this application are true and corract. � " `� DATE � ' �' S SIGNATITRE . (Schedule of Fee Coste can be found on the Reverse S de). . ' • d • n �. y . � �. � _ , G �-� B�DING PERMIT FSE SG�iEDULB SECTIOR 2. The Inepector of Buildinga sha11, before isauing any permit for the ereceion of any building or struc�ure, or for any addition to any existing building or structure, or for any alteratiotas or repairs to any existing building or structure, upon application eherefore, Yequire the payanent by the applicant for such permit of fees to the amouat �erein below set forth and in the manner herein provided to-wit; 2.1. For any such permit for the erection of any fire-proof building, other than a gara�e, warehouse, factpry or grain elevator, or for the erection of,_any fire-p�oof �ddition, for similar occupancy, to any existing building, ahall be at the rate of $1.40 for each one thousand cubic feet, or fraction thereof, in such cubical contents. . 2�2. .For any such permit for the erection of any fire-proof garage, warehouse, factory or grain elevator, or for the erection of anq fire�proof addition,..for,.similar occupancy, to any esisting building ahall be at the rate of $1.25 for each one thousand cubic €eet, classified ae "fireproof°t by Sectioa 502 of the Minneapol,is Building Code. HOUSES 2,3. For any such permit for the er�ction of any noa-fireproof _� building, other than a garage, warehouso, factorq or grain eleva.tor, or any non-fireproof addition, for similar occn�pancy, to any existing building » permit $1.00 for each one thousand cubic feet. GARAGES 2.4. For any such permit for the erection of aay non-fireproof garage, warehouse, factory or grain elevator, or for the erection of any non-fire-proof addition, for similar occupancy, to any esiseing buiiding ar for each such building or addition - ninety cents ($0.90) for each one thousand cubic feet or fraction°thereof, in the cubical contents thereof with the minimum of $4.00. For the purpose of computing fees for building permits, the cubical contents of any building or addition to a uniform height throughout by multiplying the grouad area covered from a point six (6) inches below the floor line of the basement or cellar to the average he�ght of the upper surface or to the average height of the roof aurface of the ma.in gable of a p3tched roof. 2.5. For repaire or alterations to an existing structure, Che fee sha11 be at the rate of $3.00 per each Five Hundred Dollars ($500.00) or frac�ion thereof in the cost of a11 proposed work. 2.6. In no case shall the fee charged for anq permit as set forth in Section 2 be less than $4.00. STORM REPAIR DANlAGE FEES; Residential: Estimated Cost of work up to $500.00 -$5.00 Estimated Cost of work over $500.00 •$10.00 Commercial; Estimated�st of wogk up=to`$�QJ.00 -$I0� _ _ � e Estimated �st of work over $500.00 - $20_ .1 sue�ecT P IT N O. City of Fridley o 19451 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r ; � CEIP . � `� _ COMMUNITY DEVELOPMENT DIV. �� r � � PROTECTIVE INSPECTION SEC. 1 ` � � /'�'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BV �.__.11.' �•� 612-571-3450 9t0-F15 5/6/88 / / JOB ADDRESS 15.�. CCOWIl Road N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO DESCR. 2 3 Carlson � s 5l1IDIDl't NO M3Y10]C SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Kenneth �streich 181 Crown Road N.E. 571-2485 3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO. Same 4 ARCHITECT OR DESIGNEH MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS Z�P PHONE LICENSENO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION ❑ ALTERATION O REPAIR O MOVE ❑ REMOVE X 8 DESCRIBE WOHK Construct a 16 ' x 12� 5hed in Rear Yard 9 CHANOE OF USE FROM TO STIPULATIONS Shed to at least 5 feet froqn Side and back lot line. Shed to be on Slab or tied down with ties.. TYPE OF CONST. OCCUPANCY dROUP OCCUPANCY �OAD SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATINC3, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. 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 AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEFiEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ]. STALLS 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 COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT SSOO S. 5O DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OF CANCEL THE pEqM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. S�.S. OO PLAN CHECK FEE TOTAL FEE $15. 50 aTU oFC i C RORAUTHO i2EDAGENT �D TE� � � WHEN PROPERLY VA ATED THIS IS YOUR PERMIT I v Si NA UREO OWNER�IF WNEFBUILDER� IDATEi BLDG iNSP TE �1 �� City of FYic]ley EEfective 5/L88 AD�N L � R-1 AI�ID R-2 AL�ER [ ] Constructian Address T �1 Description: Building Permit Application ) � 2. C�� f�� , �` . �—D �- =� ��l cnnl.S Owner N�ne & Address:� E�� /`4 �-7 /-� �J � S% d2 F l G/--� Tel. #S7f ��8'�S Coritractor : T�., g Address: Attach to this appl ication, a Certif icate of S�,irv�y of the lat, with the proposoed �onstruction drawn on it to scale. LIVII� ARF�: Length C�iRAGE ARFA: Length DEQC ARFA: Length �:.s�,o ._ /-� Q�rner Lot [ ] Inside Lot �l AESQtIPTION OF I1�ROVE3�'1�TP Width Height 9q. Ft. width Height Sq. Ft. Width I�gt/Groimd 9q. Ft. ��- �� /9� S�d� Ft. Yd Setback � Side Yard Setbacks � Type of Constructian: Fstimateol Cost: S� Approx. Cflmple�tion Date: ��m °� ��`7' � Proposed Drive�eay Width If New Opening Is Desired: S_ Width + 6' I]ATE : � 0 APPL ICANP : �� .5 �� C /� Pe�it F�ee State Surcharge SAC CY�arge Driveway Escrow Pa�k Fee Sewe� Main Charge � STIPUI,�IO&S: s /� � D�a S �� S S S $ /� -�� C1TY USE �Y Alt. A Alt. B S_ See Back Page Te1. #.S"S/- ��5 �ee Schedule on Reverse Side 5.50/51,000 Valuation 5550 per SAC Unit Alt. '�," or A1t. "B" Above Ftee Determired by E�girreering P,greenerit Neoessary [] No�t Neaessary [ l , , . .�; � � : 1 ��, '�: � 4 ��1 ��:I��. 1 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 maruier herein provided to-wit: TOTAL i�ALUE S1 to $500 5501 to $2,000 S2, 001 to 525, p00 525,001 to $50,000 550,001 to $100,000 �100,001 to 5500,000 5500,001 to 51,000,000 �1,000,001 and up �� S15 (Minim�a Fee is S].� plus surcharge ) � S15 for first 5500 plus $2 for each additional 5100 or f raction thereof, to and including 52,000 S45 for f irst S2, 000 plus $9 for each additional S1, 000 or fraction thereof, to ar�d including 525,000 $252 for first 525, 000 plus $6.50 for each additiona]. $1, 000 or fraction thereof, to arad including 550,000 5414.50 for first 550,000 plus �4.50 for each additional $1,000 or fraction thereof, to and including 5100,000 $639.50 for first $100,000 plus 53.50 for each additiona]. �1,000 or fraction thereof, to and including 5500,000 � $2039.50 for the first $500,000 plus S3 for each additional $1,000 or fraction thereof, to and including 51,000,000 $3539.50 for the first $1,000,000 plus $2 for each additional $1,000 or fraction thereof DRIVEfit�v �RFS.STON,_ E� (Concrete Curb Streets Only) Alternate aAa; R�naval and replaoement aE curb and gutter only - Driveway width plus 6 feet times 513.50. Alternate "B": R�noval and replaoement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times �15.75. �?�� • � • ' �.�'�1�� • �1 • � Permits for construction will be issued a minimum of 24 hours f rom the time of appl icatian to allow for proper review of the proposed structure and of the o�nstruction site. A Certif icate of Sl�rvey of the lat, shawing the location of the founolation once it has been wnstructed will be required before prooeeding with the fr�ning. � e i � � I I '�'� I 1 I ..� r.. I l �•=.,"""_r'_" ' i _'"�.�'1 I i I � 1 I i ► � I �----� I._ I I -.-�' .--- . I '�1 �' � � 1 .. • " � � � h:5 � I'-�. �''' _�..� i -{ --i ' j i � :-� r--._ ! I I 1 I I __, � �.�, -� � � 1 i City of Fridley AT THE TOP OF THE TWINS � � � � �� COMMUNITY DEVELOPMENT DIV. � ��: ------� r � � PROTECTIVE INSPECTION SEC. 1 . � � ` ��"1 � CITY HALL FHIDLE� 55432 �""� � �'� 612-571-3450 SUBJECT BU ILDING PERMIT NUMBER REV. DATE PAGE OF 910-F15 9�9�92 � � PERMI 537 �! � APPROVED BY JOB ADDRESS 181 Crawn Rd NE t LEGAL LOT N0. BIOCK TRACT OR ADDITION SEE ATTACHED oescR. 2 3 Carlson's �ummit Manor North SHEET 2 PROPEfiTY OWNER MAIL ADDRESS 21P PHONE Kenneth Oestxeich 181 Crawn Road NE 571-2485 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Leslie Tranb.y & Son Roo�ing & Siding 6917 Valley Place Crystal N�V 55427 533-3330 4 ARCHITECT OR DESIGNER MAIL AODRESS ZIP PHONE LICENSE NO. 2 5 79 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK � NEW ❑ ADDITION O ALTERATION C� REPAIR ❑ MOVE � REMOVE 8 DESCRIBE WOHK Reroo� House C12 �qua�;esj Teax.'Ro�� 9 CHANGEpFUSEFROM TO STIPULATIONS ��la�nent �tust cQmply witTi the Sta,te Building Code. TYPE SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATIN(3, VENTILATING OR AIFi CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONI 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. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALI AND ORDINANCES GOVERNING THIS TVPE OF WORK WII.L BE COMPLIED WITH WHETHER SPECIFIED HEREIN OH NOT. THE GRANTING Of A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEq PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULATING CON- TRUCTION OR THE PERFOFiMANCE OF CONSTRUCTION. PLA �� SIGNATURE OF CONTRACTOR OR AUTMORI2ED A NT IDATEI /� �, S� STALIS NCY GROUP OCCUPANCY LOAD CU. FT. OFFSTREET PARKING IGARAGES $636 MIT FEE $19.00 N CHECK FEE License SC $5.00 $.50 Fire SC $.64 �TAL FEE $25.14 THIS IS YOU PE IT �%9�''"�� T NEW [ ] ADDN ( ] ALTER [ � Construction Address: CITY OF F1tIDLEY S[NGLE FAMILY AND DUPLEXES . R-1 AND R-2 Building Permit Application ow �vKo.�Jb Effective 3/1/92 Legal Description: � 7� � , � L :� �� Sd� � `S �-� m �> i �,�1�rt�,�Pa i�� . , Owner Name & Address: ��C �✓��T// � D€ST� E/ G/� Tel. # 6 7,� -- � y�'S'_ Contractor: L� S � � E T/1s4�,� � y`� s� �v �fo v� i�v'� .�-� � S� n �ti'U MN LICENSE # a 5 7� Address: (, 9 �� `�� L L L- `� �,C .�1 C� Ce� y.s T� �!�i .� �"5 �a 7 _ Tel. # 5 33 - v 3��' v_ Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: - DESCRIPTION OF IN�ROVEMENT �g� Width Height Sq. Ft. Length Width Height Sq. Ft Length Width Hgt/Ground Sq. Ft e.l� �� ; Corner I,ot (] Inside Lot [ J Ft. Yd Setback Side Yard Setbacks � �`� Type of Construction: �� o�=',� �a-,�o �. ��' /7v c�sE Estimated Cost: $�l �-s-a-�� -�� - Approx. Completion Date: • (Cost on BackJ Driveway Curb Cut Width Neecied: Ft. + b Ft = Ft x$ _$ APPLICANT: �� ' Tel. # DATE: � ` Y __„� �� •, Permit Fee $. Fire Surcharge $_ State Surcharge $. SAC Charge $. License Surcharge $. Driveway Escrow $ Park Fee S Sewer Main Charge $ TOTAL �ITY USE ONLY � i°, �� Fee Schedule on Rev�se Side , �-y .001 of Pemut Valuation (1/lOth%) � �.:`� �� $.50/$1,000 Valuation $700 per SAC Unit �. c`- C$5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above � ��, � � Fee D�termined by Engineering Agreement Necessary [ J Not 1�lecessary (] ST[PULATIONS: . BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or sbructure, or for any addition to any existing bnilding or structure, or for any alteration or repair to any existing building or strucd�re, upon application therefore, require the payment by the applicanf 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,(100 $2,001 to $25,0� $25,001 to $50,000 $50,001 to $100,000 FEES $15 (Minimum Fee is $15 plus surcharge) $15 for first $500 plus $2 for each additional $100 or fractioa thereof, to and including $2,000 $45 for first $2,000 plus $9 for each additional $1,000 or fraction ther�f, to and including $25,000 $252 for first $25,000 plus �,50 for each additionat $1;OOQ or fraction thereof, to and inciuding $50,� $414.50 for fir�t $50,OQ0 plus $4.50 for each additional $1,(�0 or fraction thereof, to and including $100,000 $100,001 to $500,(�0 $639.50 for first $100,(�0 plus $3.50 for each additional $1,000 or fraction thereof, to and including $500,000 $5�,001 to $1,OQ0,� $1,OIX1,0p1 and up $2039.50 for the first $500,000 plus $3 for each additional $1,000 or fraction thereof, to and including $1,000,000 $3539.50 for the first $1,�,000 plus $2 for eaeh additional $1,000 or fraction �thereof DRIVEWAY DEPR�SSION ESCROW ' (Concrete Curb Streets Only) Alteinate "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 gutier and instail a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. VERIFICATION OF FOUNDATION Permits for consirucdon will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will b� requir� before proceeding with the fram[ng. sue�ee� P City of Fridley 2 8106 AT TME TOP OF TME TWINS B u I L D i N� P E R M I T r .,�,.��..� .�.� � . � � � • COMMUMITY OEVELOPMENT OIV. � j V ��'��', . r � � pROTECTIVE INSPECTION SEC. 1 . � � _ �"'1 � CITY HALL FRIOLE� SSIJ2 NUMBEr+ �°-��' �'' 612-57�-3a5p s�aF�s JOB ADDRESS 181 Crown Road t LEGAL �OT NO. B4.00K TfiACT Oii AODITION DESCR. � Q ('.�rl c�nr� � o C�r 2 PFiOPERTY OWNER MAIL ADpR�S$ Scott & Glenda Peterson J CONTRACTOR MAIL ADDRESS Best Sidin� Co Inc 1�1(1 1 5� 4 AfiCNITECT OR DESIGNER MAIL AOORESS 5 ENGINEER 8 USE OF BUILDING Residential 7 CLASS OF WORK B DESCRIBE WORK Replace sid MAII AODiiE$S DATE I PA 10/5/98 � �� OF APPROVED 811 / E SEE ATTACMED SHEET LICENSE NO LI NS NO. LICENSE NO ❑ NEW O ADDITION 0 ALTERATION Q� REPAIR O MOVE O REMOVE 9 CHANGE OF USE FROM on house: Revlac ro STIPULATIONS Call for building wrap inspection before covering. Install smoke detectors to meet the State Building Code - in each sleeping room and on each level of house. Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIREO FOR EIECTRICAL, PLUMBING, MEATIN(i, VENTI�ATING Op AIR CONDITIONING THIS PERMIT BECOMES NULL ANO VOIO IF WQRK OR CONSTRUCTION LONING AUTHOR12ED IS NOT COMMENCED V�1ITHIN 80 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANQONED FOp A PER100 OF 120 DAYS A7 � ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS I HEREBY CERTIFY THAT I MAYE REAO AND E%AMINEO TMIS APPLICA710N AND KNOW THE SAME TO BE TFIUE AND CORRECT. ALL PROVISIONS OF LAWS yA�UATION ANO ORDINANCES GOVERNING THIS TYPE OF WpRK WILI qE COMPLIED WITM WHETHEii SPEC�FIEO MEREIN Ofi NOT. TME GpANTING OF A PERMIT 6935 OOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CAMCEL THE pEqMITfEE PROVISIONS O: ANV OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTI E PERfORMA E OF CONSTRUCTION 12L}. ] PIAN CMECK f EE �-.,.e � � -�g' - S'�' �GNATUQE O� CON�A/1CTOp Op oUTNOp�ZEO AGENT IDAfEI NEN RI SQ. STAILS CU FT OfFSTREET PARKING IGAiiAGES CMARGE 4 EE ��5 IS VOUR PE M / /+ s V r��iE LOAD � rrEw [ l ADDN [ ] ALTER �(�' ConstructionAddress: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION �� c�� -- �r. Effective 1/1/98 �� o� � Legal Description: Owner Name & Address: � �� °� � � ��a %,2� �Sc+�. Tel. # S 7�2 - a .so�6 Contractor: ��s'� S ��, � �e �o MN LICENSE # ��' y� Address: ! 3 c� i S y T 4 �4�� u � h��4N- �•g-� � Tel. # `�/3 dS�v Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: DESCRIPTION OF IMPROVEMENT Length Length Ixngth ��-Q�Q.eQ S i G1.� Width Height Width Height Width Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. a„�,�- e �e}ce a � ��••clo+..�s .�.� %��-� �@P I��e (Y g-�� G �- Estimated Cost: $ / (Fee Schedule on Back) Driv�way Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ � DATE: /D- .S� -/�'� APPLICANT: � �iC�'� Tel. # �{� �' � s° o Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ >�� 5.� $ . $. $ $ �� $ $ $ $ $ �o, / CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.SOI$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 [ ] No�t 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,OQ0,001 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,(}00 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 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. �� s� � � � a �' `o m � � � �'O O j � � m �� a � s c .. � � � � 0 z m � 8 � � � ��'J w� � � '� -t. ��o m ..� � � n �rn � rn � ? � T �� z � � m � < � a OD � c m s 1 � � � � � m � � 3 � a _ � z 0 n O �D { � m �'1�•qq � � � N m G� � � an r.�, �� c r� e� z �+ ITE � � � � m � � � m N c � � � c� � � �� Q � Z m � m 3 � � m z 0 m� v � �� y a �� "' a �c '0 � � 0 0 � �g �� : � �. � � � � � � � ° o o � � N -� Z D n 3 � � � m � y � � v '� � a � � $ m � • a � � � � A � �i ��s� $�� 8: � Q C � 8� � a c m 1 i � � � � � 0 0 0 0 0 � o° °o � � o Q.,'. � � � � � � � � � � �1 0 � � c��z � o °- o � � 3 � c � � m C 3 m _ � � n � A � �n O � ' 7 � � /� G. m � � m 3 a � o = C. � .- . � � D m � 3 r�ir v � O � -i � � O -D m �o � Z O �r � , �ra � c v Z � c � m v � � �^ � � � Z � � � � N -� � � � � m � � � �~�� o ��m �m�m fp C 3 Q. IDam? Qmom � �o� ��D3 � y � � � � j A p> c3'a�'� � w � � � ' � N N � `� A � °' o �' �� a=� � A o m.sx -. Q� �, ,� o '1°+"'� � � � � `� b � O � a�� j a � � L 0 ao v v � � � � �� N� � �� C � Z� v � a� � N � � � � � z v ? � � my �o -D-� O za � Z � v� n�� n� z� vs -� z zN �� v _ �� Z -A vp �o° mz �� m . Z -� s Z \ � � � � m O � � C pl � � w CHIMNSY AND BTACR VSRIFICATION The undersiqned hereby verifies that the existinq chimney or stack: 1. Has been carefully examined Yes � No () 2. Is free fro�n rust or deterioration � Yes () No (� 3. Has no foreign objects lodged within Yes () No �) 4. Is securely supported Yes (� No () 5. Meets all current Code requirements for size and total BTO's connected Yes () No �) 6. Has total heating BTU's of . All other BTII's � ' TOTAL BTiT's � d�°� Remarks List Alterations Being Done: � I lI /�/I _ ✓I ,!. � � / ,/'_' � 1 J 0 v - �. • BLAIiJ� HTG. tA/C �� EL�CT. INC. ,-.�� ' 13562 CENTRAL AVL°. N.E. HEATING COMPANY ANOKA, MN 55304 • Signed By Date - `T .