AF - 46386Village of Fridley, Minn.
BUILDING PERMIT
Date: . . . . 'e�+�.,�' . . . . f. .��.". .`!: ,
. . �!'
Owner���r�d�� . _ °: . . f . . . . . . . . .
Address ���.�.�g':" .'°'' . . : .�^:��d�..�' . '-�. . .
1'�° � 19 31
Builder.... ... ........ � ....................
Address.............................................
�,,,,,, LOCA.�OF BUILDING
No.'�� t�,,� .�• �
. � �� . . StreeL�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Part of ��, ot . . . . . . . . . . .
Lot . .. . . .. ... . . . . Block . .. .. .. .. . . . . .. .. . Addition or Sub-Division ... �"�.'�..����;f�°�°`� s"�����
��
Corner Lot ........... Inside Lot ........... Setback ........... Sideyard ...� ...................
DESCRIPTION OR BUILDtiVG
To:=� Used as:
�� +� '� �`
�,'`.',�'���°".���.... F'ront .:�.� Depth ;�",°�""" Height ..,�... Sq. F't..��r,✓..�Cu. F� ........
0
..................... F�r nt ........ Depth ....... Height�... Sq. Ft. ........ Cu. Ft. ........
Type of Construction����'r��.. Est. Cost ...��.��`..`�".�� To be Completed ............. ..
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 village of Fridley.
"� . !�it. a�a�.=....�"��:��..�. .... ... ...
��. �_�A _
Yn �onsic}eration of the payment of a fee of $. . : . . . �,, permit is hereby granted to .!'�• .+�". .�:� . . .. . .
��'"��'� ?' ,_
. .....�. . .. to construct the building or addition as described above. This pernut is granted upon
the express� dition that the person to whom it is granted and his agents, employeas and worl�en, in all work
done in, ar d and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of build'mgs with-
in the village limits and this permi sy be revoked at any lame upon viola�ion of any of the provisions of said
ordinances. � �
,,-x°��.� d�'s.*�i�'.r, s .t ,t`
° . BUlldmg IIIB�CCtOI
RI OT I G E: �/°1'"`' -
�
7his permit does not cover the cons4ruction, installation or alteratlon fo� wlring, plumbing, gas heating,
sewer or water. Be sure to see tla�Buiiding Inspector for separate permlts for�th�se items.
BUILI)ING PERMIT
Village of Fridley, Mina. N� 2 4 2 2
Date �. ":�': �: ": :� �'.' . . . . . . . . . . . . . . . .. . . . . . . . . .
Owner .��: :?�.���, ��+;a,�`;�". . . . . . . . . . . .
Address ��,'� . �`.��' � . �-� x�z°�: , ���.
Builder .�� :'�z'°ye�.'.�,:�e't� ...........................
Address.........................................
" LOCATION OF BUILDONG
No. ..°�R��.�:�j-: .. ... Street ..�'�'C'�: �'-: � . .. ... .�'`c�.... .. .. . Part of Lcst . ...... .. .... ... .. .. .. .
Lot . . . . . . . .��. . . . . . . Block . . . .�. . . . . . . . . . Addition or Sub-Division :��� � , ;�!�F!�;��;��!�, , , , ,
s �„
Corner Lot . . . . . . . . . . . . Inside Lot . . . ±:�^:"�. . . . . Setback .��.�.�`.�:'. Sideyard �� ��":' . . . . . . . . . . . . . . . .
DESCRIPTION OF' BUILDING
To be Used as:
�a��� . . . Front . ..�j .�. . Depth �.'� . . . I3eight �,�',��.� . . . . Sq. Ft �I�'�. . Cu. Ft.
�•• ........
. .. . . .. . . . . . . .. . . . . . Front . . . . . . . . Depth . . . . . . . . Height . . . . . . . . . Sq. F't. . . . . . . . . Cu. Ft. . . . . . . . .
� �
Type oi Construction .��',����&.('. . Est. Cost e�+�+�'�� . . . . . . . . . . . . . . . To be Completed :� . .�`r�!"��:?�.��.. , .
In consideration of the issuance to me of a permit to construct the b�zilding described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with a11 provisions of
ordinances of the village of Fridley.
...................................................
�In nsideration of the payment of a fee of $. .�'�,�p .., permit is hereby granted to a�:-:l�t�r�� .-:°.':
�:'�� �=�:y': ........ to construct the building or ad dition as described above. This pernut i�s granted upon
the express condition that flie person to whom it is granted and his agents, employees and worlmien, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota. regarding loca,tion, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this germit may be revoked at any time upon violation of any of the provisions of said
ordinances. �� � ;•-�
r�...... Building Inspector
NOTICE:
This permit does not cover the construction, installatioro or alteration for wiring, plumbing, gas heating,
sewe� or water. Be sure to see the Building Inspector for separate permits for these items.
/'� ,a..
City of Fridley, Minn.
BiJILDING PERMIT
nate: _�_:__""'"' ; ° �� `w'"�.._�_.._.__.__
�
Owner: _..� .__. _� ••--------.._..... Builder
`'��- -•-�- �--•
+�j �
Address .j�._..L.,..�._...�.� � Address
�
N° 4'714 .�
.._ ..:._.._..._...._:... _._ ._..�...._.___..._._.._.._.___._.._._..__
d,a�
LOCATI N O BUILDING I
No. �..,.+�."_'��.. Street _.��� .... __ �.._..._. ._....._�.... .. .;,�i�..._..... Part Lot ._......__.---._._.._ ._._.._..____ � II
Lot ._---._._.#.�....-- ._..._.... Block ...._...�--....------...__........ Addition or Sub-DivIsfon .. ..��. . _,. . _ � ,�_;�
. . ..... . . ... ..__ i
� _,,�° �r---•• �
Corner Lot .....- ................_._........ Inside Lot .....#'"_,.••-•-.............. Setback .-�---............._....----...._........ Sideyard ..--��_....�.-------.........---------_ _-- �/
Sewer IIevation
Foundation Elevation
DESCRIPTION OF BUILDING
To .0 d s•
� f �' _.,�' �
..... _.--- nt __:�. ...,_.. Depth ,--Ic-.�--- Height _:.�(J�---- Sq. Ft �...�"��::__ Cu. F't. I G�
--- ..... _._------------ ...........:.._._.. Front •--.._.......:...._.. Depth .....:.........:.... ight ....._..��. Sq. F� ...---,...;.._....__ Cu. F� ___...-----------
..
Type of Construction ._�T"��„�... Est. Co :..:....... ....:... ��.. .��..� To be Completed ....._...._.._.._.._...--•-----.-----...
,f
������
T��J �E�'t�/;;�� �-QES W�T A,tJ�'!-i0R12E V(0(,A'T�
�CiPJ ��,F �,f�v`r' ��r:f,�A�"E �AN�D COYENrAFJTS AND
��J;L�lNG F�E:STF2fr'�I�NS.
In considera.tion 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 dty oP Fridley.
�.--•-----.......____ _.._
In consideration of the payment of a fee of ...: ............." ' '
$ :..._......:..., pernut is herebY granted to...._..__._..._.._.._......_.
� _.._ to construct the building or addit3on as descrlbed above. This permit is granted upon
the express conditfon that the person to whom it is granted and hia agents, employees and workmen, in all work
done in, around and upon said building, or any part t6ereof, ahall conform in all reapects to ttie ordinanees of
Fridley, Minnesota regarding locat3on, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time �qn�i�a tio�t''o`�i�any of the provisions oP said
ordinances. i��� r/J 1/ ��` d
Buiiding Inspector
NOTICE:
Thia permit does not cover fhe wnstruetion, inatalladon for wiring, plumb(ng, gaa heating, sewer or water. Be sure to see
fhe Building Inspeeto� for separafe permtts for these ftema.
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ownsrs Name �.
�ddreas � � `�
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APPLICI�TION FOR BUILDING PERMIT
CITY OF' FRIDLEY, MINNESOTA�
�
LOCATION OF BUILDING
�:� � �� �
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No.��=1 % %�-� Stree� ,�,� ���- ,�c. �� a ,� _ � - Part of t �w �
Lot Block � Addition or Sub.D3v, �_ -���-a�
��
Corner Lot_,,,_Inaide Lot �� 5et Back Side-Yard ��
3EWER ELEV9TION FUt1NDATION ELEVATIOAI •
gpplicant attach to thia form Certificate of Survey of Lot and groposed building
location.
DESCRIPTIOIG OF BUII�TNG
To be u�ed as:
, %
��.���.: /,,�,�,�,�2 Front � � Depth � � � Height
Sq. Ft. Cu. F�t.
F'ront Depth Height
5q. Ft. Cu. Ft�
Tarpe of Construction �, i/�,�e� Estimaied Cost
To be completed
3'he undersigned hereby makes application for a permit for the work herein apecifiecl,
agreeing to do all work in strict accordance with the Cit� Ordinances and ruling of
the Department of Buildings, and hereb�r declares that all the faots and representa-
ti.ons sta.ted 3n this app2ication a.re true and correct.
DATE ,� � �� ll �_�______SIGNATi�E `� ��� • ���
(A� chedule of Fee costs can be found on the R.everse Side.)
� _ .�
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BIIILDING PERMIT FEE 5CHIDIILE
Sect_ ion 2. The Inspector of Buildinga sh�].1� before issuing any permi-t
for the erect�on of any building or structure, or �or any addit3on to
any existing building or structure, or for any al�terations or repa3rs
to any exist3ng buildin� or structur�e, upon applica.tion therefor, require
the pa.yment by the applicant for such permit of fees to the amount herein
below set forth and in the manner herein provided,,to-wi.t:
2.1. For any sucli permit for the erection of a�y fire-proof building, other
than a gaxaga, r,rarehouse, factory or grain elevator, or for the erection oP
any fireproof addition, £or simi.lax occupancy, to ariy existing build3n�
shall be at the rate of �1.L�0 for each one thousand cubic feet, or fraction
thereof, in such cubical contents.
2.2. For an� such permit for the erection of any fireproof garage, ware-
house, factory or grain elevator, or for the erection of any fireproof
addition, for similar occupancy, to any axisting building shaZl be at the
rate of �1.25•for each one thousand cubic feet, class3fied as "f3seproof"
b�r Sac�ion 502 of th.e Minneapolis Building Code.
HOUSFS
2,3, For any such permit for the erection of any non-fireproof bu3.lding
cther than a gaxage, warehouse, factory or grain elevator, or any non-
f�suproof addition, for si.mi.],ar occupancy, to any exist3ng building.
;e�.t �1.00 for each one thousand c;ubic feet.
Ct�RAGES
2.4, For any such permit for the erection of any non-fireproof gerage,
warehouse, factory or gr�.in elevator, or for the erection of ang noa-
fireproof addi±,ion, for similax occuganeg, to ariy exiating building er
for each such buj.7.ding or addition. Ninety Gents for each one thousand
cubic feet or iia�t�on thereoi, in the cubical contents thereof with a
min�.mum of �4�00,
For the p"='UoGe of computing fees for building permits the cubical contents
of any builciir,F o� additic:� to a uniform height thz°oughout by mult3plging
the ground a�re�. covered f`rom a point six.(6) inches below the f`loor line of
the basement or �ellax to the average height of the upper surface or to the
average height of the roof sl:rface of the main gable of a pitched raof.
2.5. For repairs or alterations to an exiating structure, the fee ahall be
at the rate of �3,00 for each Five Hundred Dollars ($5fl0.00)� or fraction
thereof in tl�e cost of ��a.11 �roposed work.
2.6. In no case shall the fee aharged for any perm3t as set forth in
Section 2 be less than $4..00.
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City of Fridley, Minn.
BUILDING PERMIT
Date: November 18 1969
p�r; Mr . Hoy g�� Ben Wo 1��
Adaress —5R�2. HugheG Address 25� Ric.e Creek �er�aee
LOCATION OF BUILDING
No. 507� S{y�t � Hugl�es ._.. Part of Lot
Lot - � _ Block 7 Addition or Sub-Divisian _ Su.�it Mai'�or
Coraer Lot _ Ine�ide Lot X Setback —_ Sideyard
Sewer IIevation
Foundation IIevation
N° 10508
DESCRIPTION OP BUILDING
To be Used as: °
Rec Room �Panel�t Depth Height Sq. F't Cu. Ft
Front Depth ITeight Sq. F� Cu. F�
Type of Construction Frame ��_ 1 000. 00 __ To be Completed December 15, 1969
In consideration of the issuance to me of a permfi to cons et building d cri a e I agree to do
the proposed work in accordance with the description above fo and in ce wi provlaiona of
ordinances of the dty oP Frldley.
In conefderation of the payment of a fee of $� , permit fs h�reby granted to �en Wo lke
to cronstruct the bufldiag or addition as described above. Thisp�� t ia granted u�n
the express condition that the pe�on to whom it 3s graated and his agents, employees anc� workmen, 9n all work
dane in, around and u�n eafd building, or any part thereof, shall cbnPorm in all reapects to the ordinaaces oP
FridleY, Minnesota regardizg location, construct[on� alteration, maiatenance, repair and. moving oE buildiuga
within the dty ]imfta and thia permft may be revoked at ax�y time upon violation oP any of the provlaions,of safd
ordinances.
��'r,�'������
Official
MUHICH-Bui
NOTICEs
'Ihis permM das eof sorsr ths eomtrodfon, Iestallalloe %r wietee, plum6tee, ga 6eaNna, ssw�r er w�fer. B� son to aes
t6a Bntiding lespector for �parate parm(b fo� fh� it�ms.
�.
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OWNEEi 'S
ADDRESS �G�
APPLICATIOAI FOR BUILDING P�?MIT
CITY OF FRIDLEY, MINNESOTA
�
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BIIII�D�
Z ADDRF�S �-s� i�� `
LOCATION OF
N0. STREE;i' J�V % �
LOT BLOCg ADDITION OR SIIBDIDISION
CORNER LOT INSIDE LOT I/ SETB�CK SIDEYARD
SEWER ELEPATION TOP OF FOOTING
lpplicant attach to this form Two Certificates of Survey of Lot and
propoeed building location drawn on these Certifiaates.
DF�CRIPTION OF BIIILDING
To Be IIeed Ae: /
— �`� yl t° � C.�i � �!S
�P � o�i2 Front Depth Height
Square feet Cubic Feet
Front Depth Height
Squaace feet Cubic Feet
�
Type of Conatruction �'�' q�� Estimated Coet �%��
To Be Comple
The undereigned hereby ma.kes application for a permit for the work
herein epecified, agreeing to do all work in etrict accordance with the
City of Fridley Ordinances and ruli.nge of the Department of Buildinga,
and hereby declaxea that all the facts and repre tions s te
this app 'cation are true and correcte �
D�TE �'� SiGNATURE a-�-
�
(Schedule of Fee Costs can be fourid on the Reverse Side.)
N07.'E: A Certif ied Survey of the lot, showing the location of the f�undagion9
once it has been constxucted, will be required before proceedint� with Ytae
framing. `�
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BIIILDING PERMTT � F'EE SCHEDDI,E
SECTION 2. The Inspector of Buildin�e �ha,ll, before issuing permits
for the erection of any buildi.ng or structure, or for any addition to any
�xisting structure or buiYding,.or for any alteration or repairs to an.y
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:
IIniform Building Codee Type 1y 2, & 4-�1075 for each one thoueand
cubic feet, or fraction thereof, in such cubical c.�ontents. Type 3& 5-
$1<50 for each one thousand cubic feeto
For the purpoae of computing fees for buildi.ng permits, the cubical
contents of any 'buildin�-�Y�'�addition to a uniform heigh�t �thraughout �hy
multiplyix� the ground area covered from a point eix (6) inchea below
the floor line of the basement or the cellar to the average height.of
the upper surface or to the average height of the roof surface of the
ma.in gable of a pitched roof.
For repaire or alterations to an existin� structure, the fee shall be
at the rate of $3.00 per each iive hundred dollaxs ($500.00) or
fraction thereof in the cost of all proposed work.
In no caee ahall the fee chax�ed for any permit as eet forth in Section
2 be lesa than $5.00.
NSSSD Connection Chax$es based on location - Area 1 or 2.
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sue�ecr PEHMIT NO._^
City of Fridley 12911
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T '
i �
� � RECEIPT NO
� ; L �.�_ COMMUNITY DEVELOPMENT DIV.
r � PROTECTIVE INSPECTION SEC. ��i-y�Q�
1 �. i ✓ U
� � /"'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�'�"� � ,�� 872-560-3450
910-F15 4 22 75 � �
JOB ADDRESS 5072 Hughes Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OFi ADDITION SEE ATTACHED
DESCR. % % C3Y�.SOII � 3 SUII�LL't M3riOr S011'�1 SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Melvin Aaberg 5072 Hughes Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USEOFBUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Re-roof Dwelli.ng
8 CHANGE OF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. S�l].ri �.E
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 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APP�ICATION �- 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 $200.00 .�JO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � �`S.00
PLAN CHECKFEE TOTALFEE
5.50
SIG ATUREOF TR T ROR HORIZED ENT (DATEI WHE PROPE LY V LI ED IS IS YO R PERMIT
� - �����"w' _,
-�
SIGNATUR F OW RIIF OWNER BUILDERI (DATEI B INSP f1ATE
�
APPLICATION FOR RESIDEIvTIAL, ALTERATION,
OR AllllITiON BUILUING PERMIT
CITY OF FRIDLEY, 1�1INNESOTA
,
OWNER' S NAME :�� BUILDER ° �, .�...r e.
ADDRESS • � ADDFESS : ✓� ��;�.�
NO : . �O � �. S TREET . �- �'lS�% �7 -
LOT : �� BLOCK: r% ADDITION : 1.�� l/J UYLD �u'� �`��� ��'�"� �
`y� �Ou�
CORNER LOT: INSIDE LOT: ✓\ SETBACK: SIDEYARD:
-•-�--
Applicant attach to this form ��o Certificates of Surve� of Lot and pxoposed
building location drawn an these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
lI.` S
����,�1�. �`' Front: Depth• Height•
Square Feet: Cubic Feet:
Fxont• Depth• Heigh�•
Square Feet; Cubic Feet:
S
Zj*pe of Construction• r ����L�Estimated Cost: $ �� �� ��
To Be Completed: / i� �-�-
The undersigned hereby ma.kes applicatinn for a permit for the work herein
specified, agreeing to do all work in staict accordance with the City of
Fxidley Oxdinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated i.n this application
are true and correct.
DATE : SIGNAT[TRE •
L
(See Reverse Side For Additional Information.).
��.�.�
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�BUILDING PEF.NIIT FEE SCHEDULE
SECTION 2. `.L'he Inspector of Buildings shall, before issuing permits for the
erec�ion of any building or sCructure, or for any addition to any existing
building or structure, or fox any, alteration or repairs to any existing
building or structure, upon application therefore, require the payment by th.e
applicant for such permit of fees to the amoun� herein below set forth and in
the manner herein provided to-wit:
UnTIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORr1ATI0N
For the purpose of computin� fees f�r building permi.ts, the cubical contents
af any building or addition, i.s determined by multiplying the ground area
covered froin a point six (6) inch�s below the floor line of the basement
ox the cellar to the average heibhts of the upper surface or �o the average.=-
height of the roof surface of the ma.in gable of a pitched roof. �
For �repairs or alterations to an e� isting structure, the fee shall be at the
rate of $3.00 per each five hundxed dollars ($500.00) or fraction thereof in
the cost of all proposed woxk.
In no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTEs 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 siteo
A Certified Survey of the lot, showing tfie location af the foundation, once it
has been constructed, will be required before proceeding with the fxaminge
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall no� be used or occupied until a Certificate
of Occupancy has been issued.
��
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�
sue�ecr PER
City of Fridley . 1494
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T;
r
� � RECEIPT NO.
� `y ______ COMMUNITY DEVELOPMENT DIV. �
r � � PROTECTIVE INSPECTION SEC.
� �
� � �
l.__-� �����'� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVEU BY
L 812-580-3450
910-F15 10/3/78 � �
JOB ADDRESS 5072 Hughes Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. % 7 Ca.rlson's SU1�IIL1't �.IIOr S01Tt�1 SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Melvin Aaberg 5072 Hughes Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
d ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE IICENSENO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW 0 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Install fireplace
�
8 CHANGE QF USE FROM TO •
STIPULATIONS
Ca11 for roughrin inspection �a before any sheetrock is installed.
Install 18 inch heaxth to extend 12 inches on either side of opening.
SEPARATE PERMITS ARE RE�UIFED FOR ELECTRICAL, PLUMBING, HEATINO, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
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 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 S2OO $.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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � S%. SO
PLAN CHECK FEE TOTAL FEE
� $ 8. ��
SIGNATUREOFCONTRACTORORAUTHORIZEDAGENT (DATEI WH � P PERLY VALIDATED THIS IS YOUR PEFMIT
+ c � �
�� �" � �,.��,� �' t .� � 3� ' , .
; �`� � �� -� , � �� . :�
� SIGNATURE OF OWNER IIF OWNER B LDERI � IDATEI BLD . INSP pATE
.
J _
CITY �or- f(tIllLCY ,
' 11PPLTC/1TIOt� FOft (ZL"SIll[:NTIAL. BUILDI�IG PEf2MITS .
' ��1�L"W, �LTL"R�TIOfJS, �Dlll?IOIJ�, OfZ REf'AIRS)
� ��
ota���R: � e -1 0 ,�,�i�l �3 � %� ��- nuzr.v��z: ��l E? C- l/ / ���/ ,��-•�� 1.� � /� �
, �
Address : S O�i a%� l>G %i e S/V F_ Address : �
Tel. 210. :
Ho. :,�"�'� � street: ,�1 v� N e S /l� � .
� �
LOT: [ BL(}CY.: � ADDITION : �� �� � TYL��,( l � ,/�1Q/� �
. .��-�-�
COI2IQER LOx: INSID� LOT: SETBIICY.: SID�YAI2DS:
Applicar,t attach "to L-his fozrn ��o Certiiicates of Survey of Lot ar�d proposed
• bui].ding location drawn on these Certificates. •
DESCRIPTION OF BUILDIhG
S
To Be Used As:
. � ,
• �j12 (�Pi.-I�� Front: Depth: " ' Height: "
. Square Feet: Cubic Feet:
�rront: � Depth: � Height:
' Square Feet:_ Cubic Feet: '
Type o£ Construction: �' �/; 1E'. �� � G° °�_„_ Estin►ated Cost: $� G�� o 0
xb Be Completed: � . Alt. A Alt. B
Proposed Driveway i�TidL1z If l�ew Opening Is Desired $ $ '
' (S� I2�VERSE SIDE OF SHEET)
The undersigned hereb}� makes �pplication for a permit for the work lierein
specified, agreeing to do all <<�ork in strict accardance ��ith the City of
Fxadle�� Ordinances and rulings of the Deoartment oi Buildings, and hereby
declares that all tlze facts and representations stated in i.his application
are true and correct. �See reverse side far aclditional ini'ormation.
� .
DAT�: - 7 � SIGNATUP.E: � '-•
Stipulations: . ' / %
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. � , , �� �
,��� (/
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�� ,.,(,/ ! g'' ��' � � - � � � o�*�
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/ Z-'� dt'a't°�`�-- �� 8 C7� � �
CITY Of" t=1tI0LCY • �
/if'PLIC/ITIU'J f�U�t f;ESIDI:P1TI/1i_ QUILf)I�1G PEP.��TTS
((dct•r, All:er-aLions, AddiLions, or Repairs)
OtdIdCR: ���� .�,��%�e��r
nU��css: �� 7�UG f�e s i�/ �
.
TCL n�0: ,�� D�l �� 1� �
�UILDf:R: . � .
/IUDRESS: �
TCL FdO: -
Consl:ruciion Loca�ion "
sxr�cx.rio: ,�Q ?�� sx��:�:T: �-I U GHes ��le ,ll��f�.1�7G� y � �ih�y
G'/4 /�5 o n/ , ,
Loz�: ,�� � BLOCx: '-�-��nnzTZOr1: ,�UN►/�i i�' /l�Anlo1? So .��1��
�
Corner Lot: Insic3e Lot: �^ Setback: Sideyards:
Ap�licant at�ach to this form twa Certificates of. Survey of lot and
. proposed building location dra;an on certificates to scale.
DESCRIPTIOiv OF COP�STF:UCtIOPd -
I'ront: � D�pth: Height:
Squa�e. Feet: C�i,bic Fee�:
, k'ront: Depth: Height:
Squar.e• I'ent: � G�xbic I'eet:
�'ype of Cons�ruction : e $ / � �°. Esi.�:mated Cost: $ �� �
Zb Be Oor,�pleted: �[� �, y /,y' - 1��� .
` � - Alt. A A1t, B
Proposed Drivec•�ay Width If New Opening Is Desired: $� $
, . . SEL R�VER,i; STDE OF SfIEET
x3ie under.signed liea:eby ma}.es appli.ce-�ta.cn i'or a permit for. the t:vr]c� herei.n specified,
agreeing �o c.�o ,all work ir� s�L-rict accordanee �•�itii the City of I'ridley Ordi�iances and
rulings of t11e lleplrimen� of Buildings, and hereby declares that all the facts and
ZC�2'CSCilf.1�].OIlS stated :ii this «pplicatian axe true and corxect.
D1:TE: �g�r- �� 1 Y' � I SI�N21TUi:'r; :
5ti��ulations : �
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. IsUlL1)II�1G i't_ftl�J'(' f=L:�_ <>(:{I(:I�UL�� `�.. .
:;l;C:'.t'�Ol�� 2. �'1.'l�c�. 7n�.���cci:c�r. of: llui.lclit►�J:: ::liri].1, befozt: i;s�.�i.ii�J ��c:�inzt�:; Tor t:he erc:cti.on
af ���iy l�u:i.l.rl.i.n�l a�: :�i::.'uct:uz'c, w: fc,�: t��i�� aclQi.t:i��n t:o �u�y _n_r,i.�L•�:nc1 },uilc13au1 or :>L•nicLur.c,
. cir f:c�)• ariy til.t:c�r..it:ic,n vr. r.cl,�iir. , L•o �any c::a.r:l:in�� )n�i.).di.iicJ oz sL•�:ucturc, �a}��n ar�p�.i.cation
�tlxr:J:�.f.or.c, r.cqu.i.re tJi� l�r�}��nci�L• ?�y t>>c aj���a.i.car�t: fc»- :�ucl� ��cr.ini.l• ot.= fec:, tc� L-l�c �nou�it
hcr�-.iTi b��l.aai ;;r.l• tor.th a�1Q �.�i t.lic i�anricl: hcrc�.n ���ovzcic:cl L•�-�•::i.t: .
l�):1•1 G'�)1d::�1'];UC`�IOI�: Sing7.e l.'amil_y Ilotr,es and Gcs�-.zcr�s: ;:�.00/J.,000 cul:,xc tec:�. '
PLI:?•2 (:II3:�'1,: ?.5 I�er.cc��i: aL huS.lcli_n�J }�er.miL L-ce.
lllti:t�I:l•;AY llLl'P.e:5S201•i: (ConcrcL-c, �'�irb �i:rcet� Only) �'
' 111.i:crn.-�t.e n: lte�noval atid reF�].ac.r.n,ent- oL- concr.e�e cur.b and
quL-L•cr. only; l�riveway �•�iclth pl.us 6 ieeL• x$13. �0
1#lt�rnate I3: Rrmoval and re���.acement o£ concrete curb and
• � gutter and i.iist��ll a,', �'ooL �•�ic�e anProach t��ith �'
� . .� 6 inch depth; briveway a�ic:th �p].us G feeL• x$1�..7�
• . _1�L�r-��onn.� tr,r-or���1l1TION
Por the pur��se oi compui:i.ng tees' for_ build�.ny pezmits, L-he cubi.ca)_ co;;tents of any
build�.ng or_ addi�ion, is deL-cr_:ni.ned hy rnultipl_��ax�g ':.he ground arez cuvered ironi a
pui_�it si•r. (G} inches belo;� the floor )_�.ne oi tlie basemeni: or the cellar i�o 'tiie .
average hei.ghts oi ihc �up�,��r surfacc or to i:he �tverage ileight of the roof-. surf_ace
of t3ie iaain g�zbl.e of a pi.tclled roof . •
Foz re�zi_rs or alterations io an er.isting strticture, the fee shall be a� the xate
of $3.00 Z�ex each five hundred dol.lars `($500.00) or fracL-ion 'cliereaf. a.n the cost
of all proposecl wor.k. . . •
In •no case slia.'..l the fce cliargeci for. any pennit as set ior�h i_n Section 2 be �.ess -
t2�n $7. SO pl.us $. 50 stai.e surcharge. � • '
, _ v�RrFrc.�szou oF �=our�nn�-tor�
NOTE: Perm�ts far COriS I:1't1G1:1021 wi�l be issued a minimum c�f 24 hours fr.om t1i� t3„tne
vt api�licatian to �-��.].ow for proper review of i.he proposed structure and oi the ,
construction site. �
A Ceri;i.fa.cate � of Survey of the lot, sho�aing the locati.on oi the faundation once i.t
has been cons�nicted ��*ill be required bei`ore �r.oceeditiq �•rith the fiami.nq.
..�I�TIFIGATE QF ��CUPI�(�'C�' � '
��tsPP�.i�ata.on for a Ceitiiicate ot Oceupancy sha11 be mad;� �en (10) d��ys pr�ar ta the
u::e or. accura�zcy oi any sta.-ucture ior �ahic}i �i lauil�i:i.»g pexmit l2as bcen issuc�cij c'LIICY
s.iic2 st�rnct:uze slial]. iiot Z�e used ar. occupied L:iitil a Cer.tS.iicz�e oi C�ccu��zncy has
bccri x�sucd,
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CHIMWEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes (,)
2. Is free from rust or deteri�oration Yes ()
3. Has no foreign objects lodged within Yes ()
4. Is securely supported Yes ()
5.
�;�
�
Meets all current Code requirements for size and
total BTU connected
Has Total heating BTU's of
All other BTU's
TOTAL
Rema rk s
No ( )
No ( )
No ( )
No ( )
Yes ( ) No ( )
Com pa ny
Signed By
Da te
..
c�ty of Fridley
AT THE TOP OF TNE TWINS � � I L D I N G P E R M I T
;,
,�
� ; y ����� � COMMUNITY DEVELOPMENT DIV.
f � � PROTECTIVE INSPECTION SEC.
L_--•� ��"'�•� CITY HALL ff110LE� SS132 NuYBER REV DATE P�GE OF
t 61Z-571-3450 9t0-F/5 9/24/98 / �
JOB ADDRESS 5072 Hughes Ave NE _
t LEGAL LOT NO. BLOCK TRACT OR ADDITION
oesca. 7 7 Carlson's Summit Manor South Addn.
2 PROPERTY OWNEfi MAIL ADDRESS 21P
David L Serie 55421
3 CONTRACTOR MAIL ADORESS 21P
Owner Same
d ARCMITECT OR OESIGNEfi MAII AOORESS ZIP
5 ENGI
MAIL ADORESS
21P
7951
����
AVPROVEO B�
SEE ATTACHEO
SNEET
MONE
572-8253
HONE LICENSE NO
MONE LICENSE NO.
PMONE IICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW C� ADDITION O ALTERATION O REPAIR D MOVE O REMOVE
8 DESCRIBE WOHK
Garage (28' x 12' x 13') Addition
9 CHAN(3E OF USE FROM
TO
STIPULATIONS See notations ori plan. Provide a hard surface driveway.
Variance approved for a 24.5' setback from Main Street Property Line.
SEPARATE PERMI7S ARE REQUIRED FOR ELECTRICAL. PLUMBING, NEATING, TYPE OF CONST OCCUPi
VENTILATING OR AIR CONDITIONING.
TMIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONS7pUCT10N ZONING SQ. FT
AUTHORI2ED IS NOT COMMENCED WITMIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONEO fOR A PER100 OF 120 DAYS AT
ANY TIME AF7ER WORK IS COMMENCED. NO. DW�G. UNITS
1 MEREBV CERTIFV THAT I HAVE READ AND EXAMINEO TNIS APPLICATION STALLS
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF'LAWS ypLUAT10N
AND ORDINANCES GOVERNING TMIS TYPE Of WORK WILL BE COMP�IED �( , 384. OO
WITH WHE7HER SPECIFIEO MEREIN OR NOT. TME GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOIATE OR CANCEL TME pEqMIT FEE
PAOVISIONS OF ANV OTNER STATE OR LOCAL LAW REGULATING CON• @ 124. 7S
STRUCTION OF TNE PERFORMANCE OF CONSTRUCTION '�'
4TUNEOFCON7RACTOpOA4UT11ppIjEDAGENT �O�TEi
�.�G 4`� s�y�.� �— ��/— ��
TUAE O� OWNEA�i� OWNEpBU�LOEA� IDATE�
OCCUPANCV�OAp
OFFSTAEET PARKING
IGARAGES
SURTAX
$3.19
SAC CMARGE
. re SC $6.38
TOTA EE
$134.32
t
.
� .
NEW [ ]
ADDN [ l
ALTER [ ]
ConstructionAddress:
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
sc� � a
� , ���
�t= /`C�< < � �
Effective 1/1/98
���
�� i���
�✓
I.egal Description:
Owner Name & Address: �.`} � � � � . �.�Z./ C Tel. # S �v� "�S �� �
Contractor: �w�➢ � MN LICENSE #
Address: ��-e
LIVING AREA:
GARAGE AREA:
DECK AREA:
-� �q-� ✓--�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length �g Width /a Height ��
Length Width Hgt/Ground
Tel. #
Sq. Ft.
Sq. Ft. �3�
Sq. Ft.
OTHER:
o� .
Construction Type: � �O'� Estimated Cost: $ �� �
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �-� �%� �g APPLICANT:
r �j ����
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ � �S-
$ 10.3 �
� 3 `9
$ �_
$ �f �
$
$
$
$
CITY USE ONLY
Tel. � -S i �' ^ r�l �S' �
Fee Schedule on Reverse Side
.001 of Pemut Valuation (1/lOth%)
$.50/$i,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 [ ] Not Necessary [ ]
$ l� . �
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 $2,0(?0
$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
$1,000,001 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 $1,000
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 $100,00Q
$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
$1,000 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.
Altemate "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 $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
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'o _
sue�etT PERMIT NO. �
c�ty of Fridley 2 8194
; ` ��������E�►'"S gUILDiNG PERMI o
� `v _ COMMUNITY DEVELOPMENT DIV. � �� �
r � • � PROTECTIVE INSPECTION SEC.
i = �
� �"'1 � CITY MAIL fRIOLEr SS132 NUMBEp NEV DATfi PAGE OF APPROVED BY
�.---�: �., 612-571-3a50 s�aF�B / /
10/13/98
lOB ADORESS 5072 Hughes Avenue NE
t LEGAL �OT N0. 9LOCK TiiACT OF ADDITION SEE ATTACHED
DESCfi. ] 7 Carlson's Summit Ma.nor South Addn. SMEET
2 PROPERTY OWNER MAIL ADOR�S$ ZIP PHONE
David & Patricia Serie 572-8253
3 CONTRACTOR MAIL ADDRESS ZIP PHONE IICENSE NO
Owner
A AFiCNITECT OR DESIGNER MAIL AODREBS IIP PNONE LICENSE NO.
5 ENGINEER MAII ADDpE$S 21P pHONE LICENSE NO
8 USE OF BUILOING
Residential
7 CLASS OF WORK �
❑ NEW ❑ ADDITION O ALTERATIQN [� REPAIR ❑ MOVE O REMOVE
B DESCRIBE WORK
Reroof house and garage (18 S) Tear-off
9 CHANOE OF USE FFlOM TO
STIPULATIONS �
Underlayment must comply with the State Building Code.
SEPARA7E PERMITS ARE FiE�UIRED FOF ELECTRICAL, PLUMBING, MEATING, TYPE OF CONST OCCUPANCY GROUP OCCUPANCr �OAD
VENTILATING OR AIR CONOITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. FT CU FT
AUTMORIZED IS NOT COMMENCED WITHIN � OAYS. OR If CONSTRUCTION
OR WORK IS SUSPENOED OR ABANQONEO FOR A PERI00 OF 12p OAYS A7 '
ANV 71ME AFTER WORK IS COMMENCED ' NO DWLG. UNITS OffSTREET PARKING
I HEREBY CEFTIFV THAT I MAVE REAO AND EXAMIN�O THIS APP�ICA710N STALLS GAiiAGES
AND KNOW THE SAME TO BE TF1UE AND COFiRECT. ALL PqOVIS10NS OF LAW$ yp�UATION SUR7AX
ANO OROINANCES GOVERNING TMIS TYPE OF WQFK WILL QE COMP�IED
WITH WHETHER SPECIFIEO MEREIN OR NOT. TME GRANTING OF A PERMIT $1542 �, ]]
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE Ofi CAMCEL TME pEF�MIT FEE SAC CMARGE
PROVISIONS OF ANY OTHER STATE OF LOCAI LAW REGULATING CON-
STRUCTION OA THE PERfOFMANCE OF CONSTRUCTION �SI.ZS Fire SC �L.SZ
PLAN CMECK FEE TOiA� FEE
53.54
$�GNATUFIE O� CON7i7ACTQA Op oUTMOp�2E •GENT �O�TEi
Q WNEN PROPERLY LIOATED TNIS IS Y UR PERMIT
�� � �2�.� . �o -� � - �� ��� � �— 3—��
S�GN4TUAE Of OWNEQ��F OWNEi1BU40Eiii IOATEi . BlD �NSp � qdit
b
NEW � l
�DN I l
ALTER [ ]
ConstructionAddress:
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
�a
�r /�/��. ��.1
Effective 1/1/98
��
�� 0�
��
� !YliV . �S`�/�- i
�
Legal Description:
.
Owner Name & Address: � � d� L� e'��z �� ��- ��2 /� Tel. # 5�� '� ��
Contractor: `��; • MN LICENSE #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Tel. #
DESCRIP'I'ION OF IMPROVEMENT
�,��,
LIVING AREA: Length `�� Width ,� �iU Height �,C f Sq. Ft. ���
GARAGE AREA: Length 2 8 Width 3U Height /� , f�.S Sq. Ft. ��O
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
� �� 17 .�� �/l.S'd
Construction Type:_ ��� o� ��C���� Estimated Cost: $ � f`/2 �'
. �
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: ��'� �� -°�� APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
ST'IPULATIONS:
$ °' 2�
$ � �Z
$
$
$
$
$
$
$
$ �'3, �i
r
��.�/1 �/ �
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
Tel. #
$.50I$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 [] Not Necessary [ J
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 pernut 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
$1,000,001 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 $1,000
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
$1,000 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)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Altemate "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.
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CHIlyIlVEy AND STACB VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes (�) No i)
2, Is free from rust or deterioration Yes () No ()
3. Has no foreign objects lodged within Yes () No ()
4.
5.
6
7.
�
Is securely supported
Meets all current Code requirements for size
and total BTU's connected
Has total heating BTU's of
All other BTU's
TOTAL BTU's
Has a liner been provided for water heater
Has combustion air been provided for water heater
Remarks:
List ALTERATIONS BeinQ Done:
Yes ( ) No ( )
Yes ( ) No ( )
yes ( ) No ( )
yes()No()
HEATING CO:
Signed By:
Date: