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City of Fridley, Minn.
�UII.DING PERII�IT
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Owner .......................................
Addre�s ......................................
N° 33�9
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Builder ���.....�:":�.�` ���'
.......................
Address .............................................
LC?CATION OF BU[LDINC
No.�.��..���..� Street .� .............. ................ Part of Lot ............... ... .. ,, ` �
Lot . . . . . . .'��"�. �B2ack . . . . �. . . . U� , , �: ;� � . �� . . .�`����t �
..... Ad on or Sub-Division . ...... .... �
Coraer I.ot . . . . . . . . . . . . Inside Lot . . . . .� . . . 3etback �� � yard t +�
.. �.�:. ... S9de .,��'.�... �' ..:"�' .:........
DESCRIPT[ON OF BUILDING
To be Used as: �
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. .�.� . 2: : -.�s: : . . . . Fraa►t . . . . : . . Depth � . . . . Height . . . . . . . . Sq. Ft. �. � .`�.�. Gii. Ft ;': �. :`� �
.................... F'ront .. DePth ........ Height ........ Sq. F't. ........ G�. Ft. .......
T�►pe of Construction �'.�^:°:�:� . . .. . �. Cost�.�. ��. �..�: . To be Completed . . t�`": f: . .�'�'` . . _ . .
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In �onsfderation of tihe issuance to me of a permit to conatruct the building desribed above, I agree to do
the prapaaed work in accc�rdance with the descclption above set forth and fn complfance with all provisions of
ordinaaces of the dty of Fridley.
�.�... .... .........�.. . .................
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In consideration of the payment of a fee of $.�.:..::':":.., permit fa hereby granted to ...................
. . . .. . . . . . . . . . . . . . . . . . .. . to conatruct the bu9lding or additian as described above. This permit is granted upon
the express conrlitfon that the person to whom ft is gisnted and iris agents, employees and wor�en, in all work
done in, around and upon said building, or any part tliereof, shall conform in all respects to the ordix�anc�es oP
Fridley� Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the dty limite and this permit may be revoked at a�y time upon violation of any of the provisfons of said
ordinanc�. .
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. 6?�.� . �: : ':':��. . .� suslaittg Inspe�mr
NOTICE: ���1 _
This permlt does not cover the construatlon. IneEallaf,lon or alteratlon for wlring, plumbing, gaa heatlne.
�wer o� wate�. Be su�e to eee tha Bulidlne Inspaotor for sa{r��rate permits tor th�se Itema
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G1TY LOTB
TOPOORAPXIC MMPINO
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C. E. COU LTER
LAND SUIiVEYOR
REOISTERED UNDER LAWB OF 8TATE OF MINN6SOTA
LICENBEO BY ORDIMANO6 OP CITY OR lI1NTtEAPOLiB
3300 LYNDALE AVE. 50. MINNEAPOL.IS 9. MINN.
TAYLOR 4-0370
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Pnae� suavers
LAKEBNORE
JYD�CIAL
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I hereby aertify that the above is a true and c�orreet p3et of 8 st1'r4ey � s
Lot Forty-two (!�2), B1oc1€ �ro (2), PAI�{VTETa► i�IGHTS ADDITION, Aaoka C�,tnty. M�nnesote.
As surveyed by me this 16th dey o� September 1958 �. D.
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� P�Iiaaesota R .stration No. 258u
City of Fridley, Minn.
BUILDING PERMIT a 4 s 8 s� -,)
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Date: ...____,�..._.,C�.._..""r_.__.r.. � _..._._.�
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Owner: ..��.,C.�' � .:: .�� �--a �.�'f''�' : r�� Builder •-_----_...__.._......
, -......._._------.._.......__..._......._____..___._._..�...._
Address ...,��...��__ �r._ •- ,��'�.:.�.�.if Addresa
�,,�---- •-- ------•- ----- _.. _----.,..__......_.---------.._.._...._..
�, CATION OF LDING
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No. _�:.... ..�..... 5treet _ ' � �--- Part Qf .._._--•- � ...._.....---...---
---- .:.._. .. ... .. ._ . •---.._...._ _.
-_ . ..._ _....
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Lot -- ...� :.............. Block ....._................�........_ Ad tion or Sub-D vIsi _.. �Q.: ..._s:;.�:�,�[�'.� ►�°...:-�!. . - -- .
� � � �,�"� '' -- � - �- • - -
Corner Lot ...._ .........................._.. Inside Lot ..... --.../�"".'..". �.. �rtback .... .:--"���r"..�.. .''�`.�-�Sideyard -- •--�....----...._._.---------._............---------
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Sewer Elevation ---.._..-�-•-•---•--...._.._...._.._.......----•----•--�---�----�-----._ ....................... Fo dation Elevatiott •--- -••----......------........._.._..-----�--......_----•-------------•-------------
DESCRIPTION OF BUILDING
To Us as• •
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... �..��'--...._...---� ---�:�.1 Frontr�...._�-....-- Depth ���_-:.. Height �� Sq. F� ��� Cu. F'� (�=�'.��.�°'�
.._......._'"....... .�. ... . L
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...._ ............. --... ... .....--------�� - -.. o .�..........._- Depth ....:.... �. ei t ..... .... �,�. Sq. F� ----._....__....__.. Cu. F� ....._....._......--
Type of Construction .... .::.._--....R:'.:°����.... Est. Cost��' ,�. ........:..�.........._.... To be Comrleted ._.._........_..._. _.
In consideration of the issuance to me of a permit 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 city of Fridley. �,
In consideration of the � ..°"':`. -��
AaYment of a fee oP $...(�j -- --•, Permit is herebY granted to...----.--..----.....-----•--•-.---....--•-.-.-•-------•
..._. ___._____..._.�.._..._. 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 workmen, in all work
done in, around and upon sa.id building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesoffi regarding location, construction, alteration, maintenance, repaia� and moving of buildings
within the city limits and this permit may be revoked at any time upon vio�,p,tion of �y of the proeisions of sa3d
ordinances. s�'", �! �i'
Building Inspector
NOTICE:
This permif does nof eover the eonslrueHon, inatalleHon fo� wiring, "plumbing, gaa heaHng, sewer or water. Be sure fo see
the Building Inspector for separate permits fo� theae hems. , ____�„�� ���
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� THIS �`MIT DOES NOT AUT�Ot�'iZE"VIOLAT-
' IO1M OF ANY PRIb'ATE LAfVD COVENANTS AND
,�•t �l! UI�'dG RESI RICTlONS,
APPLICATION FOR BIIILDING P.�NIIT
CITY QF FRIDLEY, NIINNESOTg
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Owner'e Name ��tC�`T��� L �-���"�a.ilder�
�cldress _���� f���-�'������� o��d�'ess�
LOCATION OF BIIILDING
No. ��� i Street -��� �' Part of Lot ��.�
/ e � p � �G""� `°'
Lot ��" � Block �� Addition or Subdivision C���2.�-���
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Corner Lot �_Inside Lat 3etback Side�-Yard
SEWER. ELEVATIpN FOUNDATION ELEV'ATTON
�pplicant attach to this form Certificate of Surve�r of Lot and proposed building
loca.tion.
To be used as;
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Type of
To be Completed
DESCRIPTION OF BIIIT.�ING
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De�th � �
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Sq. Ft. /� S� Cu. Ft. � /�' O
Front Depth Height
Sq. Ft. Cu. Ft.
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ted Cost � / ��
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The undersigned hereby makea application for a permit for the work herein specif3ed,
agreeing to do all work in str3ct accordance with the City ard3.nences a.nd ruling of
the Department of Buildinga, and hereby declares that all the facta and repreaentetiona
atated i.n this applica.t3on are true and correct.
DA� �' � � ' � � SIC�iTATiTRS C��c�,�.��� ��`-G�-��
(A Schedule oi Fee Costa can be found on the Reverse Side.)
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SUILUINt3 PE�IT FBE SCAEDUlS
Segti,gn,��, The Tnapector of �ildi,nngs +�ha7.1, bePore iasu�n6 e�► P�tmit fo�r the
erect�.on of ar�;y �ui7.$ing ar structwce, or for auy addit�cn t►fl at�y e�d.�t�ag build-
ir�g or ei�uct�re� or Por e�ny a].t�ratioae or rega3ra t� a� �siat3� bu�,7.dtng or
struoture, upon application f.herefcr � r�uire the pa,ment by tiie +�pglie�ut Ppr
r such permf.t of fee� tfl the ea�ount here3a below sat fartrh snd in the �e,�r laerein
provided to-tir3.t s
2.1. For ar�r �ch permit for the eremtion o! ae� f9rer•praof bou�i.lding� ot�har t�han
a�arage� varehou�e, factory or grain elee�tor, aa� tor t�►e ere�tien oS e�y fyx'e�
groc� sddf.tion, for eimiias e►o�wPancy', to s�► eximti�g build�ng v� be at �h�
rets of �1.1�4 fer. eaoh one th�v.ee�nd anbio feet, or ,tl�aatiaa t�eree�t io �h
�l o0s�t�a.
2.�. Foe a+� +�neeh pe�i'E � tAr �t�oa �t ��04 At'i►p� �a�
tsmtv�y sr grain e7.�vstari or lraar t�s a�aofi�eo� ot at� i'!�! +additS�oa, !'ar
a3toilar o�c�upan�►� to a�,1r su?.�t�+g b�u�7.�g sl�7l be at t�s �ra,ts o� $1.25 P0�
e�ch one tbeusawd c�biv feet, oleeai£�d �� ��lse�ool� 1�r Seotd.�� '.�G2 0! t�s
I�nneapelis Buil$�►g �de.
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2.3. For ar� suah perm3t �or the ereo�iou of a�pr aan•flssproor bui�.a�g •th�r
thsa a garsge� r�esehouse, fac�ory er �n elev�tor or aqq �•Ylsegroo!
eddit9.oa, far s3milar oao�u�aY� 'b0 aaY exist�g b�ldl.Ag� Permi$ �7.�00 !br
eaah one thou�nd cubis feo�,
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2.�,. For any such permit for the erectioa oS er{p a�•i'f.r�prc�! Be�sge, �rette$o�e�
Factory or grain eleeator, or for the erect►i� o! a�y ae�tirepra0! sdditi�a, ta�
similar occupauoy, to ang ex].atin� buildix�g or for eaob au� buildi�g or eddttios�
Ninety Centa for ea.ch eue thousend oubic Peet or �►otZpa �epf� in the c�u'b�es7.
confi.enta thereof with a miriimum of �1�,,00�
For the p�pope of Qomputiag �ees for building perml.'t.8 the oubi�l c�ntente oY as�q
build3n� or addition to a unifarm heiglnt throughout by mu7.t3plyittg tbe grouttd �es
covered Prom a point six (6)-inc,hes below the floca' ].ine Of the basem�nt or Ce1�.ar
to the avarage height of the upper surface or to the avera,ge ��'lght o� t�e roet
sur,�ace of the main gab�.e of a pitched°°roof.
2.5. For repa3rs or alterations to an e�c3sting gtsuQture, 'tbe fee si�7. be at th�
rata of �3.00 for each Five Hundred Dollers ($500�00)� or f�rsetioA the�oP iti the
cost o� all propoa�d work.
2.b. In no case shall the fee charged for any perm3t as set Pa�th iu Seotion 2 be
less thaa �1�.�.
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sue�ecr PERMIT NO.
c�ty of Fr�aley 12200
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T •
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r � PROTECTIVE INSPECTION SEC. �� y
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�4 1 /"'�1 � CITY HALL FRIDLEV 55432 NUMBER REV. OATE PAGE OF APPROVED BV
"'�"� � ,�� 612-560-3450
910-F15 6/25/73 � /
JOB ADDHESS 1091 Ha�haway Lane N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. /a,2 2 Parkview Heights Addition SHEET ACHED
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Vemon Keina.nen 1091 Hathaway Lane N.E.
3 CONTRACTOfl MAIL ADDRESS ZIP PHONE LICENSE NO.
52�2
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASSOFWORK � NEW � ADDITION
� ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBEWORK �onstruct 16' x 16' Addition to Dwelling and Basement Alterations
9 CHANGEpFUSEFROM TO
STIPULATIONS
SCPERATE PER�IITS REQ�1��� ��� ����
h9�ATING, PLUM�ING AND SIGNS.
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOCl FiS1Il2
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1 256 �
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY 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 �5p OOO. OO L. SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCT�N OR THE PERFORMAN E OF CC�NSTRUCTION. _ �.O.00
� P�AN CHECK FEE TOTAL FEE
,�Ps�iy� o� $" $12 . 50
j- SIGNATUREOFCONT CTORORAUTHORIZEDAGENT (DATEI H PROPEALY VALID E THI IS Y UR PERMIT
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SIGNATUREOFOWNERIIFOWNERBUILDERI (DATEI BLDG INSP DA7E "
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A�PLICATION FOR RESIDENTIAL, ALTERATION,
OR AUDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME : �10 � � r � q� � � BUILDER : .� � i� �
ADDRESS : ,IDe �, �o �, �-���Gi� ��ADDRESS :_ `S a. l�YJ �t
N0: . � STREET:�� �� � � c� e,� 6�� �n � /���
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LOT • � BLOCK • ADD TION • �� �r �� s � �r% ��� � �-�
CORNER LOT: INSIDE LO • �
T•1 SETBACK; SIDEYARD;
Applicant attach to thia form ltino Certificates of Survey of Lot and proposed
building location drawn on theee Certificates.
�ESC�tIPTION OF BUILDING
To Be Used As:
�a�'�'0 � �
� �'� Front: Depth• � Height: �
' ,�� !Y� 0 e �o o '►�
Q h � �a�� �� �S�+aare Feet : ,-�.._� , � Cubic Feet :
��y ��%'� � �. Froat : Depth ; Height :
Square Feet; Cubic Feet:
�►pe of Construction; (,�/e� e% �y�� e Eatimated Cost; �
_�,���
To �e Ccnnpleted: _1 y Y
The undexeigaed hereby makes applicativn for a permit for the work herein
apeeified,� a�reeitig to do all work in stiict accordance with the City of
Fridley Ordinaacee and tuliage of the Departmeat of Buildinge, and hereby
declares that all th� facte aad representatfona stated ia this �pplication
are true and correct.
. �.
DATE • .��,,,,� � SIGNATURE : � �
(See Rever�e Side Fax Additioaal Information.) �
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� �U�L��NG PER�dI� F�E SCHEDULE
,� SECTION 2. The Inspector of Building� shall, before iasuing permits fox the
. erection of any building or structure, or for any addition to a,ny existing
building or atxucture, or fox any alteration or repairs to any exiating
building or stxucture, upon application therefore, require the payment by the
� applicant for such pereai� o� fee� ico the �nount herein below set farth and ia
the tn�anner herei�. pravided to-wit :
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UAIIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousaad cubic
feet, or fraction theraof� in such cubical contents. i�pe 3& 5-$1.85 for
each one thous�d cubic feet.
ADDITIONAL INFORMATION
�or ttie purpoae of computing fees for building permita, the cubical contents
of any building or addition, ia determined by multiplying t1�e ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average
heigl�t of the roaf surface of the main gable of a pitched roof.
For repaira or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all, proposed work.
Tn no Ga.�e eha11, the fee cha�ged for �ny permit as set faxth in Section 2 be
le�s than $5.00,
VBRIFICATION OF FOUNDATION
NOTE: Permits fox eonstruction will be iasued a miitf.�um of 24 hours fram the
time of appli.c�fiion� to a11ow for proper review af the proposed structu�e and
of t.l�e co�netruc��.�n �i��.
A Certified 5urvey of th,e lo�, showi�g the loeation of the foundatioa, once i�
has beea const�xcted, will b� required befare,proceedinr� with the framing.
CERTIFICATE OF OCCiJPANCY
Appli,aatfon fox a Certificate of Occupancy sha11 be npade ten (10) days prior
t4 the use or occupancy of any structure for Which a building permit has been
issued; aad said e�xucture shall not be used or occugied until a Cextificate
of Occupancy ha� beerc i,ssued.
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IMOY6TRUIL.
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TOrOO11ArNiC MANINO
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fJloc.s� 2, l�•v,�',c'✓ic v✓ f/Eis,�s�rs �400�r�on�
C. �. COULTER
. + iAND SURVEYOR '
� REOISTBRED lJ1VOER LAWS OF STATE OF MINNHSOTA
L1C[NS[O tT ORDINANO6 Or CiT'Y Or MINM[AppLli
3800 LYNDALE AVE. 50. MINNEAPOLIS 8. MINN.
TAYLOR 4-0370
SURYfY l�o,(' �K�,o E. ��,��so,y d.�� r��
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I herebycertiPy that the abcve ia e true end correct plat of a survey af:
� Lot Forty.•txo (1;2).. Block �ro (2). P�..�{YIE41 H�I,r,H�'� 6DPiTIOP�. Anoka Caunt.�� A;iunesote.
a►s'$urveyed by me this lbth d�y of September 195ti A, D. "
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Si�ed � 1.�� F- �t..
t'inneso�a i; :stration �� 2�t;�
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City of Fridley
4T iNf; TOP 01� tME TwINi
-----�� GOMMUMITY OEV�L,O/MENT QiV,
� MOT�CTIVR r1f�CTIpN 0�/T,
�' ' i CITr NkL IAIpLRY iM�
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�o� Aaares.a
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i° rnan �-Q /�na �P
Contracto
Q �Kind of Building
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PLUMB I iV� PERf 1 I T APPL I CAT I Oid
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Plumbing Fixture Rates: N0. RATE TOTAL
Number Fixturea g _ x $2.00 �/ ,�Q
Future Fixturea __ X $1.50
New Fixture-Old Open. x $1.50
Catch Bastn �—
�,_ x $3.25
Water Heater-99,000 BTU � x$3.00 � 0
Ground Run Old Bldg. x 3.25
$ ,_._
Elec. Water Heater �_ � $2.00
Gas Fittin Feas:
lst 3 �ixtures �_ X $2.00 o�.(�O
Additional Fixtures
____— x $ . 7 5 _..—._
Gas Range-199,000 BTU _� x ,55.00
Reaeirs � Alterati�
See
Deacription; Code
State Surchar�e �50
i
I TOTAL FEE $ � I ..�U
�
!The undereigned hareby makea application for a perm�.t
for �he work herein specified� agraeimg to do all work
in strict accorda.nce w ith the City Ordiaances and rulin
of the Department of Buildi.nge, and hereby declare that
a11'the �acta and repxesentatione etated in this
appliea�ion are true and carrect.
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City of Fridley 3 028 �
AT THE TOP OF THE TWINS g � I L D i N G P E R M I T
r
; ;, RECEIPT NO.
� �� __��� COMMUNITY DEVELOPM�NT DIY. ��� �
f � � PROTECTIVE INSPECTION SEC
i.._. j;��'�,•� CITY NALL FRIOLE� SS�32 NUMBEp pEV D�TE PAGE OF AVPROVED B�
� l` 61�-57�-3450 g�aF�S 9/24/99 / /
JOB ADORESS 1091 Hathaway Lane NE
1 LEGAL �OT NO. BLOCK TRACT OR AODITION SEE ATTACMED
oescR. 42 2 Paxkview Heights Addn. SMEET
2 PROPERTY OWNER MAIL ADpR�S$ 21P PMONE
Steve Eggert 571-4576
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Country Craft Hms L.LP 21236 Cleary Rd NW Anoka 55303 753-9709 20192293
d ARCHITECT OR DESIGNER MAIL ADORESS ZIP PMONE LICENSE NO
5 ENGINEER MAIL ADDRESS ZIP PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS Of WORK
❑ NEW O ADDITION ❑ ALTERATIpN � REPAIR O MOVE O REMOVE
8 DESCRIBE WOfiK
Reroof house and garage (27 Sq,) Tear-off
9 CHANQEOFUSEfROM TO
STIPULATIONS
Underlayment must comply with the State Bui.lding Code.
SEPARATE PERMITS ARE REGUIfiED FOii ELECTRICAL, PLUMBING, MEATINa, TYPH OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING Sa. FT CU FT.
AUTHOR12E0 IS NOT COMMENCED V�!ITMIN 80 DAYS. OR IF CONSTRUCTION
OA WORK IS SUSPENDED OR ABANOONEO POR A PERIQD OF 12p OAVS A7
ANV TIME AF7ER WOFK IS COMMENCED. NO. DWIG. UNITS OfFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE iiEAD AND EXAMIN�D TMIS APPLICA710N STALLS GARAGES
AND KNOW TME SAME TO BE TRUE ANO CORRECT. ALl PROVISIONS Of LAW$ yAIUATION SURTAX
AND ORDINANCES GOYERNING TNIS TVPE OF WQFiK WILL �E COMPUED
WITM WMETHER SPECIFIED HEREIN OR NOT. TME GRANTING OF A PERMIT 2360 �.. �.H
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOIATE OR CANCEL THE pEWM1T FEE SAC CMARGE
PROVISIONS OF ANY OTMER STATE OR LOCAL LAW REGUTATING CON-
TA CTION OR TME PERfORMANCE OF CONSTRUCTION HJ�.ZS F1T SC Z.36
si�r�'e�� A PLAN GNECK FEE TOT FEE
� t�� License 5. . 9
S�GNATUAE OF CON'RACTOp OA AUTHOA�2E0 NT IO�TE� N P OP ALID � MIS IS V UF1 PERM
1
r I
S�GNATUAE O� OWNEp��� OWNEA BWLDEpi �O�TEi � B�0 iNS� ' Tf
�, . �
NEVV [ ] �
ADDN
ALTER
Effective 5/10/99
[ l CITY OF FRIDLEY
(?�] SINGLE FAMII.Y AND DUPLEXES R 1 AND R-2
BUII,DING PERNIIT APPLICATION
Construction Address: �
f,�� cr
0
0�
�6�
-, . � .
Legal Description: �:e - �L" �'� �� �"�a E /`'7C
,
Owner Name & Address:�'%u-� ����er� �a 7/ d�l��-� ��'�� ��e� �ci� /ey Tel. # �%� � �%" �j ��
�
Contractor: �e.c.��'o�',.� �.1d�F�,��' �, F lvnv�cErrsE���09�9�
Address:,°��1�� (f'/d•� �a��'� � �. `�`r,�� Tel. #�'!�-�9`�3 %"���
LIVING AREA:
G�RAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
laESCItIPTION UF IMP�iOVEMEI�1'�
Length Width Height Sq. Ft.
I.ength Width Height Sq. Ft.
Length Width HgtlGround Sa. Ft.
Construction Type: �� �i w �, Estimated Cost: � � s � � :� �,�+ � T
Driveway C�rb C�t Width Needed: Ft. + 6 Ft = Ft x$
_$ �
DATE: � � �- p � APPLICANT: ,� �t R o f ,� � � � �%r � Tel. # 6%l � �� i�' �� i
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ � -� ��'
� ��.j�
� /. /��
$
$ � . ��
$
$
$
$
$ ��
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 [ ]
,� < . ..,,.
BUII.DING PERNIIT 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,
ugon application therefore, require the paymern 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 $1�,000
$100,001 to $5(�,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3 .OS for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for iu�st $�,000 plus $14.OU for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,OOQ plus $10.10 for each additional$1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.001 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 tunes $15.50.
Alteruate "B" : Removal atid 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 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 �����tt�dd will
be required before proceeding with the framing.