AF - 43266' � � SuB�FCT� . - �
City of Fridley 30541
�
AT THE TOP OF THE TWINS � � I L D 1 N� P E R M I T
� � RECEIPT NO.
� ; � �� COMMUNITY OEVELOPMEN? DIV. ����
r � � PfiOTECTIVE INSPECTION SEC.
�
1 = �
� �"'1 � CITV HALL FRIOIE� SS1J2 NUMBEh REV O�TE v�GE Oi �PVROVEO Br
�----�' �•' 612-571-3450 910-F15 11/22/99 / /
JOB ADDRESS lg3 Crown Road NE
t IEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACMED
DESCR. j 3 Carlson's Summit Manor North SFiEET
2 PROPEiiTY OWNER MAIL AODR�S$ ZIP PMONE
Steve Meyer
J CONTiiACTOR MAIL ADORESS 21P PMONE LICENSE NO
Owner
4 AqCMITECT OR DESIGNER MAIL AODRESS ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS 21P PMONE LICENSE NO
8 USE OF BUIl01NG
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATIQN �c REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage (20 Sq) Tear-off
9 CHANOE OF USE FROM TO
STIPULATIONS �
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE i;EGU1RED FOfi EIECTFICAL, PLUMBING. HEATING, TYPE OF CONST pCCUPANCY GROUP OCCUPANCY LOAD
VENTI�ATING OR AIH CONDITIONING-
TMIS PERMIT BECOMES NULL ANO VOIO IF WORK OR CONSTRUCTION ZONING SQ. FT CU FT.
AUTHORI2ED IS NOT COMMENCED VtIITHIN 80 DAYS, OF IF CONS7RUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PER100 OF 120 DAYS AT
ANV TIME AF7ER WORK IS COMMENCED NO DWLG. UNI7S OfFSTiiEET PARKING
1 MEREBY CERTIFV THAT 1 MAVE READ ANO ExAMINEO TMIS APP�ICATION STA�LS GARAGES
ANO KNOW TME SAME TO BE TRUE AND CORRECT. ALl PqpVISIONS Of LAW$ yqLUAT10N SURTAX
AN� ORDINANCES GOVERNING THIS TVPE OF WpRK WILL BE COMP�IED
WITH WHETMER SPECIFIED HEpEIN Ofi NOT. TME GRANTING OF A PERMIT �1748 �,8]
OOES N07 PRESUME TO GIVE AUTNORI7V TO VIOLATE OF CANCEL TNE pEqMIT FEE SAC CNARGE
PROVISIONS OF ANY OTMEF STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR 7ME PERFORMANCE OF CONSTRUCTION $63.15 Fire SC �1.]5
PLAN CMECK FEE TOTA� FEE
S�GNOTUAE OF CON'AACTOp OA 4UTNOAQED AGENT IDAT�� NE P Y VA�I� T TMI$ 1$ V U P
r
S�GN41UqEO�OWNEp���OWNEABU�LDE�1i �D�fE� Bl �NSP r�itE
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ADDN
ALTER
Effecrive 5/10/99
[ ] CITY OF FRIDLEY
[] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUII,DING PERNIIT APPLICATIOIV
,� _ . ����h j��l, �t/�
Construction Address:
Lega1 Description:
Owner Natne & Address: S �z� r/� /'� � �� !'� ' Tel. #
Contractor. � (�t> �r � � • NIN LICENSE #
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Width Hgt/Ground Sq. Ft.
OTI�R:
� ��� _ (�� �O
Consiruction Type: ��Be-� ��� Estimated Cost: $ % 7��
Driveway G�rb Cut Width Needed: Ft. + 6 Ft =
DATE:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License 5urcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
APPLICANT:
$ G' .�. lS
.P ! e / J
$ � �7
$
$
$
$
$
$
6S �% `i'
� c�
Ft x $ _ $
Tel. #
CITY USE ONLY
Fee Schedule on Reverse Side
.�1 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 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 [ ]
Q � �4(
� ��y
�
BUII.,DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing germits for the erecrion 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 $2,0�
$2,�1 to $25,(�0
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $SQ0,000
$SOO,QO1 to $1,000,000
$1,000,001 and up
t I� �.y
$23.50
$23.50 for first $5(}0 plus $3.05 for each addirional $100 or
fraction thereo€, 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 fracrion 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
$1,0� 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 $1,000,0� plus $3.15 for each additional
$1,000 or fracrion thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "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
Permits for construction will be issued a minimum of 24 hours from the time of applicarion 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.