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Z � D - � Z � � O � L � � � a � � W ✓�-�- � — � � a��d �ig paubT g � �1�I�d1ni0� 91�iISil�H :auoQ IIiag suoi�2�a�t� �siZ ����� l%� � , � � S�[.�E,IId�j P " �- J / S � nss �so.ti , . n n O �j� S � II.ZS .zaii�o TZK _ _ � � _ � 3o s�IISS buz��a� T��o� sEH '9 () oH (� sa� pa�oauuo� s,�g T��o� pu� azTs .zo3 s�uauta��rnba� apo� �ua.z�n� TT�e s�aayl • g ( ) oH (� sa� pa�.,zoddns �Ita�n�as sI • � () oH (/�) sa� LITi�TM pabpot s��aCqo ubTa�o3 ou s�H '� () oH (,% sa� uoi���oT�a�ap .zo �sn.z uzo�3 aa�3 sI • z () oH (� sa� pauim�xa ATTn3a��� uaaq s�H -t :x���s �o �Caurazu� bui�sixa au� ��� sat3T.zan dqa�au paubTS�apun aus Hois��i�aixse x��rss ar�r a�ig� 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 [] �] Ll 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: � � ��� �� �Q� DUtility Line Repair/Relocation �ater and Sewer Connection �� 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: $ � �� �;� G��l�i� � �� �� % � %� ���l� �� (.� � � �`,,, .�� 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