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HEAT LOSS ATE G. I ST.
SOLD BY " INSTALLE
Eleetrical Work By Gaa Line B
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MAKE MAKE OF BURNER _
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Smoke Bomb Wiring -�'z �
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sue�ecr E R
City of Fridley 2 6 9 9 3
�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
� � RECEIPT NO.
� `v __�__ COMMUNITY DEVELOPMENT DIV. ����
r � � PROTECTIVE INSPECTION SEC.
�
`_-_. � ��"',•� CITY HALL FRIDLEr 55432 NUMBER REV DATE PAGE Of APPRpVEO BY
L •�� 612-571-3450 9t0-F15 8/5/98 � �
J09 ADDRESS 6901 East River Rd
t IEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACNED
DESCR. 1 /{ OStIn8.I1S - 3rd SNEET
2 PROPERTY OWNER MAIL AODiiES$ ZIP PMONE
Russell Josie 5 2-80 2
3 CONTRACTOR MAII ADDRESS ZIP PHONE LICENSE NO.
Francis Fran.cis
American Roofin Const Inc 23624 t 55070
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
753-7451 20109395
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage (18 Sq) Tear-off
9 CHANdE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATIN(i, �PE OF CONST. OCCUPANCV GROUP OCCUPANCY LOAD
VENTIIATING OR AIR CONDITIONING.
THIS PEFMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NIN(i SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAVS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OF; ABANDONED FOii A PERIOD OF /20 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEFEBY CEFiTIFY TNAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GAqAGES
AND KNOW THE SAME TO BE TRUE AND . ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING T YPE OF ORK WILL BE COMPLIED
WI7H WHETHER SPECIFIED H N OR NOTy-THE G G O A PERMIT $1501 �. 75
DOES NOT PRESUME TO E AUTMOR TO LATE O&' CANCEL THE pERM1T FEE SAC CMARGE
PROVISIONS OF ANY O ER STAT R L AL LAW GUTATING CON-
STRUCTI OR TNE P RfORM E O STfi ON $.51 . Z.r7 Fire .SC �1 ..5�
PLAN CHECK FEE TOTAL FEE
Licens SC $5 00 $58.50
IGNA URE OF CON � R OR AUTMO ED IDATEI E P �Y VAL ED THIS 1 Uii P RM
S�GNATURE OF OWNERiIF OWNER BUIIDERI IOATEI �
OG �N ryqiE
rrEw
ADDN
ALTER
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ConstructionAddress:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERNIIT APPLICATION
� � 1 l�� ) � � � GC�� � �
Effective 1/1/98
�� v\
���
�
,
I.egal Description: �c� � � � ��'� ��'�E'� �' 2 /� �'L �c�
Owner Name & Address: _ _ �c.�,� �C_. ( ( ,� S 1 �, Tel. # �7 Z ' �� 7 2-
Contractor: �� � c.E„�, � � � � � (�-� � � MN LICENSE # �sJ l (g � ^j ?,��
,
Address: � �i� (Q 2 4/� ��.w� �. f {��'� Tel. # �-3 � % �%
LIVING AREA:
GARAGE AREA:
DECB AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
DESCRIPTION OF IlVIPROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
, ��;�_o�.��t�,P
.-� '�
Construction Type: �� p c`� � Estimated Cost: $� /� ��
(Fee Sche e on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft —$•
DATE: (�j ��PPLICANT: Tel. � � — % 4���
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
. STIPULATIONS:
$ �/. �S'
$ 1, SZj
$ �-��'
CITY USE O1�TLY
Fee 5chedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$ $1000 per SAC Unit
$ f�� O$5.00 (State Licensed Residential Contractors)
$
$
$
$
�%'%,—" =
.f r - ��
� -�
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [] Not Necessary [ J
�� -SZ�
_., s �
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official sha11, before issuing permits for the erection of any building or sta�c:tr�e, 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 $5(�
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$5�,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,�0
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 $SO,OQO
$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 addirional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,OOfl or fraction thereof, to and including $1,000,000
$5012.25 for the first $1, 000, 000 plus $2.75 for each additional
$1,�0 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 �he foundation once it has it has been ror���.���d
will be required before proceeding with the framing.
-� - �
City of Fridley
" 6431 University Ave NE
Fridley 1VIN 55432
(763) 572-3602 or Fax (763) 502-4977
Water and Sewer Permit Application
❑ New Connection
❑ Existing
Date:�,l-���(7�
Job Address:
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�Q�
DUtility Line Repair/Relocation
�ater and Sewer Connection
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Name of Applicant (Plumber): � (,�i�,`��
r. , , , � _ /' � � ti I
Name of Property Owner:
Existing Structure Permit #
Pemut Type: Sewer Fee:
Water Fee:
Meter Fee:
Repair Fee:
Relocation:
State Surcharge:
SAC Charge:
Special Assessment Fee:
Total: $
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�;� G��l�i�
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% � %� ���l�
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Applicant Signature• i���'�"�
Inspector approval:
Water Meter R air — Weekend & Holida s ' $125/hour
Water Connections Permit $50
Sewer Connections Permit $50
In ection Fee for Water/Sewer Line Re air $40
S ecial Assessments See En ' eerin
Cost of Water Meter See Utili Billin
SAC Chaz e $1450
Sta.te Surchar e $ .50
Water Ta See En ' eerin
04/04/OS