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AF - 47161City of Fridley, 1Vlirm.. �UII.DING PEI�IT �:_ �_ � N° � 840 . Date: - � �, ��--�: ...... ,,�� -�' , ;� �� Owner: -��= fi � � � 1'r..•'��uilder _ � �f �--_.___.. Address �iL_. Address _ „ ��,. ,� 6 � LO�OIV OF ,�ILD,�RlG I�, No. �,�.€._...L.�� .Street "`"';�+�� ' �''' � � b"�_ Part of L�ot � , o �I Lot .�.�:� __ Block �� -�� Addition or ��Divisioa � _ � ��.`�-�-� �4'j I `� „s / av�'�� Corner Lot — Inside Lot Setbacl� ,�`�.�'� `- 'deyard Sewer IIevai3on �_ , Foundation IIevation �__._ _ �� DESCRIPTION OF �UILDING T sed �8: ' � ,r'� l �� , � ��' �� ' � � - `� ��.� i� � �.;s� nt °�` ��.DeP��_,�. Height � � Sq. Ft � � �� y ' Fron Depth '� IIeight Sq. F't ____ Cu. F� z, � � .: ,.� .�`�* Tj��e of Constt�tction '<' '�a �-,�'" ..�` Est.�.�„! Y��-� '"'""'_"°To be Completed _. In considera,tion of the issuance to me of a permit to consiruct the building described above, I, agree to do the proposed work in accordance with the description above set forth and in compliance with all provisiona of ordinances of the dty of Fridley. 1� Ia consideration oP the payment oP a fee of $�: ""'� �� , permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express co�dil3on that the person to whom it is granted and tus agentt�� employees and worlanen, in all work done in, around a,nd upon said building, or any part tiiereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding la:ataon, construction, alteration; maintena,nce, regair, and moving of buildings within the dty ]imits and this permit may be revoked at an� time u o vialation of�y of the provisions of safd ordinanc�a , a, s� °'"`~��'/" �' � �'!� `'�Buil or _ � di�►S InsPect NOTICE: ThYs peneH does not eove� the eonatrueNoe, iesfallation fo� wirU�g, plumbing, gae heaHnB, sewer o� wate�. Be are 10 ses fhe Bufldiae leapeqar for separate parmhs fo� theae Itema. �. - -, ,�" /"'� 4 /�\ :� � -,:-��' APPLICATION FOR BUILDING gERMIT , CZTY 01� FAIDLEY' MINNE30TA Owc�er' a Name�J� �- �' ��, � �_ Fe� r, � Builde� Addreas � �,� ' � fiION OF BUILDYNG No •� J' /�,_ %,�1 � Street Part of Lot Lot • Block, Ad tion or Subdivision� Corner Lot�_Ineide Lot__Setback Side-Yard l6�WLR SLEVATION FOUNUATION II.EVATION Applicant attach to this form xwo Certificatea of Survey of Lot and proposed buildiag location drawn on thes• Certificates. DESCRII�ION OF.BUILDING To be used as: � / / t� � ont � Depth HeighC S� Ft. Cu. Ft. Front Depth Height Sq�. Ft. : Cu. Ft. Type of Canstruction Eatimated Cost r To be Completed '° `"r The uadersig�ned hereby ma.kea application for a permit for the work herein specified, agreeing to do,akl work in strict accordaace with the Citq of Fridiey Qrdinances and rulings of the Department of Buildings, and hereby declarea that a�.l the facts and repreaentations stated in this applicatioa are true and corr�ct. � . f . �NA'�E.;: , . 4 ~ c� SrC.NATURE ?�' � �, ,y.� ';j�...' � . �� ;f�5ch�dule�af �'.ee Coats can be found on the Reverae Side). ' � �1 ,,,�,- -- BU7ZDTNG PERMLT FEB SGiiEDULE �� Section 2. The Inspector of Buildin�a ahall, before iesuing any permit for the e:ection;�gf e.ny �uilding or structure, or for any addi�ion to aay exist- ing building os structure, or for any°alteration� or repaira to �nq exis�ing building or stcructure, upoa applicatio�r therefor, reqiaire the paymea� by �he applicant for such permit of feee to the amount herein below set �orth and in �he maaaer herein provided to-wiC: 2.1. For any such permit for¢the eiection of aay fire-proof building, other Chan.a�$arage� warehouse, factory or grain eleva�or,'or for the erectioa of any f�re-proof addition,aefor similar occupaacy, to aay existing buildirtg shal�l be at the rate oi' $1.40 for each oae thousand cubic feet� or fractioa �hereof, in such cubical contents. 2.2. For any such permit fos �the erection of any fire-proof garage, warehouse, fac�tory or grain elevator, or for the erection of any fire-proof addition, for similar occupancy, to any existing buildiag sh�a11 be at the rate of $1.25 for each oae thousand cubic feet, classified as °1fireproof11 bq Section 502 of the A�t.nne�polis Building Code. .: NOIISES 2.3. For any such permit for the erection oi aay non-f�reproof buildiag other than a garage, warehouse, fectorq or grain elevator, or any non-fireproof addition, for similar occupmncy, to ax�y euisting buildiag - permit $1.00 for each oae thousand cubic feet. GARAGES 2.4. For any such permit for the erectioa of any nou-fireproof gar�ge, warehouse, factory or grain elevator, or for the erec�ion of aay non-firepsoof addiCion, for aimilar accupancy, to any existing building or for each such building or addition - aine�y cents ($0.90) for each one thousand cubic feet or fraction thereof, in the cubical contents thereof with a minimum of $4.00. Fox the purpose of computing fees for building permits, the cubical conteats of any building or additioa to a uniform height throughout by multiplying the ground area covered fram a poin� aix (6), inch�s below the floor line of the basement or cellar to the average heighC of the upper surface or to the average height of the roof aurface of the maia gable of a pitched roof. 2.5. For repairs or alteratioas to an exis�ing structure, the fee aha11 be at the rate of $3.00 per each Five Huadred Dollars ($500.00) or fraction thereof 3n the co�t of all proposed work. 2.6. In no caee aha11 the fee charged for any permit as set forth in Section 2 be less th�.n $4,,00. !�� 4 y � � �� rA � � O � a � : � : °x :Y . m . m . ~ : o . a . m o� � : � � {p {� � �:� � � F+ !'� �•a � � � � � � � W � o � �° � .N � . o � o � o � : O . . � . . � . . x � >C �a ie � � � °o 0 0 � {fl �69 H a � � � rq 3 � cZo � w cZa � Z 7• 8 � � 2 � 4� �� x w � � � � � �i y : O � � � � � o � � � � a ° � � � eu �. �: m o ; �� . � � . . . . � . . . . ' bd : : : : : � : : : : No x x �e �a �e x w N w r ►� � � C�i p C�7� O O' O � {fl {A V3 fi! {�! b9 � �eU O �� 0 � x � � y � A• � °� � O � n, D � r � � m N^ `I 2 e�i C r m o � I w z � � � o � � � � � n z � ° i � � � � � � � � � � m � � p0 z z° � O �, � • � y n' "` � x „� �' � a. �' � Stories 8 �t w�r�rs ER M @ CLOSETS � � URINAIS , � BATH o �'� a � \ ews�Ns k7 � I SINKS � �, W� � TRAYS DRINK. FOUNT. sHwRS. 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M E� a N � � � fp ,�` w iii p � �^ o b � ( � S� M� Q� 1+ � Q \ � � O � x r t� Y � y x x � � r � p %y y y z o x � d � � � o �,��x �� -.,� H M � � o � � � m � �� O � 0 , � � � w u~i y � ¢. � M � w c�i u4 v k o � � � � � m o� o � o � : o . � � : � : : �a x x o N � 0 0 � � �� 0 r � � � � m � � O � � b0 '� � � O 0 0 0 0 0 � � 0 0 � O r b0 � x °e � y I w 0a W w � � � � ., � x � o � � o ��., �: �� - � W • �: O N� M � �* � w `'' � � r� � � � � � O � O � � � � � :° h t�i � b �. � 0 0 � � � p. � �p M. �i � F� � � O v� � �\ p � � t� �� 0 0 � � � � x �°n O � w w �' p' a a N o 0 0 � � �� x� �� n p �° x � O � a �° � � � � � o �0 m � � � � � � N � � � 0 0 0 0 .�� 0 � z � 8 � A � � � � � � � 0 0 � � \ I� � m � .i O A O b � �. g � . � � � x �m.� � � � � � � � � � � � � �' � � � � � ro � � � O � � � s ��$� � � � � � m � � � � �, � ; � � �o: = � � � Sg: : o o . . . � � : : : � .�. N � � N � 0 0 0 0 0 � .� �. � � � � � � m O "'� M � r � � < � •f � m � � 7d A � S � � .b � w � m � � y � � � � � � � � � � o � � � � � � N 0 0 � �y y � �a � a'� � ° a � � � ��:: �•°: : 0 0 . . o . . S: : : � � � � � � o 0 0 Q000 � O � p�� A ��r � � � M � � '� f;,, a fp � �, � _ m C4 � w°��' `��° � � �. �. `•`• �� d��. ��; � ��°� � pp�OC � �°o� y �"� y �. m bd �' � b ��'w n �y' �'�d �� p��: ��'�� y K �� a� �.� � ~�� l�D M W w� ar a� fD � `S � G p e� �. � N �. � � in �i � D � � � � m H 2 m C m � � b ;y O M � �° a v � � o 1 � a � � � � I� o \ � � � � � � � � �o � � �' O � -. �� o� � O 3 d O � � �O � • A 3 0 � 0.� v< � � �_' �, o O. � �v � � � � O. 1 � � � �-. � � � � a d� � a�� qpp� � m�� z n � � W �i a � f�D 'n�" � � � Fi 'd -�i � O � O � ~ � � � o y`�� x�°� °4 a � `�' �o �' � � � � 5' : � � o � � �i a' ro • � �j • � �.., . ,'� �d : O � � � ; i$ � � � � �a a' p � y . x � � �p 0 : I v ; " a ° : � � . � : M � �y ' : bd m ; �' °a � : M �y 1 . Oa � . . . . ' � "i • . . . � ' . . . : �: . . . . . . ' a ~: : : : . : : : : . �,. . . . . . . . • � . . . . . . . . . : v : . . . . . . . . : � ' c+ N y : m � : o O t" ; �a �a �a a�a �e k k x k � : � �' � � � � �'a � � � � � 3 �� g � � 0 8 � � � � s�a � � o� O� ro y H O O O y y � � N � � r D � m � � 2 m C r m � • �P W p ►+ GJ -�x w p, � y x� � �� MS @ � � o� a p � � i � � �� 8� � o � � o y [ � � �Q ��o� � �, x � � � o� �' � o � w � ► � � � � a, �' � � � � � � � 0 � m �y a� � � � � � � x � o� � � o � �� 1,' � � 'I I _ I WATER CLOSETS URINALS e�►n+ ruas e�sin� SINKS wasi+ rnnrs DRINK. FWNT. 5��. ROOR DRAINS �� BASINS AUTO WASNER GAS MPL GAS RANGE GAS OPENINGS a • z s � � � A � � �a� b �� ro a 0�5'�' H � � � � � � o � � 5' � G �a �°�� . � b��b � ro � y � � p � m o � p' o p 'S 'Cy, o ti ��w � � � � � � �B� y ��W� �� m � o �� ro � 3 � f=. � ° � ;� � E� � � �� M a M R� &� p � M � �� i � � n � � �, �o � a � � � o � � � � � ; �y � � o .0 m � � � � w � co � � � � �Jt F-� sue�ecr ERMIT . City of Fridley - - - A� AT THE TOP OF THE TWINS g U I L D I N G P E R M I �° .15 7 7 r � � RECEIPT NO. � ; L ______ COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. � i � � ��1 � CITY HALL FRIDLE� 55432 NUMBER REV DATE PAGE OF APPROVED BV �"'""� � �� 612-571-3450 910-Ft 5 6/4/80 / / JOB ADDRESS5745 JSCICSOTl St. N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ].'rj 5 Donnay's Lakeview Ma.nor SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE John Jaeger, 5Z45 Jackson St. N.E. 571-7880 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. The Roby 0�., 7208 James So. 869-8330 4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO, 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 6 USE OF BUILDING Resi._dential 7 CLASS OF WORK � NEW O ADDITION %J� ALTERATION � REPAIR ❑ MOVE O REMOVE da 8 DESCRIBE WORK Re-si.ding, including soffit & facia 9 CHANGE OF USE PROM TO STIPULATIONS SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TMPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. R�-Si.d7-ng THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 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 STAL�S GARAGES AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL 8E COMPLIED ,4iOQ�•OO Z.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 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- 2L.E � OO STRUCTION OR THE PERFO MA, O� CONSTRUCTION. `� �� PLAN CHECK FEE TOTAL FEE 26.00 'IGNATUREOF �ONTRAC OROR UT 2EDnGENr �D 7 i WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT �s�+ _ SIGNATUREOFOWNERUFOWNERBUiLDERi iDA7E��~ BLDG iNSP Dt+TE �� .. , �. _ .� . ,. � . ,:.��. , , : . . _ , ., .; �:�, CITY Of' F(tIDLCY � • ARPLTCl1'I'l.0id FOR RCSIDCPJTI/11_ QUILUIP�G PCRMITS (tdevr, Al��rations, Additions, or Repairs) ' OlrlldER: �r�n� �c��{�t� l3UILDER: . � ADORFSS': �%'�� `°"° _ I� � . nUDRCSS: �' � � � TfL N0: r`7l °'7�� TEL (��0: ,��9 R�� ' Cor►struction Locaiion . aTRE�.:7.' NO : �� STF2�ET: _=:_��JJ'°'�f U�'. f (�C � - .:.. L07.': . / � 33LOQG: � ADDITION: ��l�S ��'t°� �(%I � /��,�I�l�� . T- Corner Lot: vl Tnsicle Lvt: � SetbacY.: Sa.deyards: App].icant attach to this iorm L-wo Certificates of Surv�y of lot and ' praposed build�ing ]�ocation dra�an on certificates to . scale. ��,�i°,uG DESCP.�PTIO�d OF CONSTRUCTI�N � E r' � r d c A��✓r?�.cy'��iv� `s`� F:cont: /1' 1.�- � l�epth: Height: Sq�?a�e. Feet:Y G1a.bic Feet: Fr_onte Depth: Height: Square� Feei:: Cui�ic Feet: ��,pe a�E Cons�ruction: �//�LyL • �stimated Cos�: $ ��G''G',Gc� ----r------ 'ib BE.' CbIQj�1.Ht.ef1: e•�•o� � ,,,_, � ! � � �� Alt. A Alt. 13 Pxoposed Driveway ��iidth If Ne�v Opening Is Desired: $' $ . SE� REVGRS� SIDE OF SHEET• 7�9ie uiadea-signed hereby makes application for a permit ior the work hel:ein specitied, agr_eeitag to do all �vork in strir.t accordance with the City of I'ridley Ordinances and rulings oi the Deparimet�L- of Bui].di.ngs, and hereby declares �haL- alI the i'acts and representations statced in this applica 1 Dt'1�E : __e�� S 1 GNATU F.E : Stip ations; ��Psr-� T � � 7, Ov • . • �`%l� ra A . �i`� � _ � �u ��°. �o ��, � �� .�. . . IIUILll11JG PCR111T rCc: SCfICDULG� . u1.C'1.'�U2•� 2. '1'l�e 7n:;��ector or I3iiil.cla.neJ:� :;}�a).7., },�for.c �.:�suing perrnits �'or l:he erc:c�ion of any l�uil.cl.i.nc� or. :.Gruct:ure, or. �o�- n»y ac1Qi.L•i.an t;o any er,i�L•inc� buildincJ nr stnicLwre, . cir S.`o�- any �Zltcrat:ioii or. ze��aa_r.:; to •a�,y cr.a.��tin�� }�ui.]a5.r�g oi ::L�:ucL-ure, U�)G11 ap��lica�5.on �L•ticr.eior.c, rec�ui.re L•}�c paymenL• l�y tl�e ap��].i.canC for. �;ucl� per.m�i: o� �ees to. tlie amounL- hcrcin bc.l.ow seL• forL•h and i.n L-hc mannex' hcrcin �rova.clecl L•a-wiL•: � l7l.NJ CO2JSTP,UC'J.'7UN: 5inc�].e l.'amil.y llomes and Gar.aqes: $4.00/J.,000 cuba.c �ee�. • I?JJ�t•1 Clil•:'Y.: 7.5 per.cenL oL- bu�.lding pez-�ni.L fce. , URTV1.1•rnx 1)�1'I2LSSI011: (ConcreL-c, Curb NticeL-s Only) � • Altcrnat:e A: Removal and replacetnenL- of• concreLe curb arad gu�ter only; Drivcway H�idtli plus 6�eei: x Y�S.o75 %lternaL-e II: Rcmoval and repl.ac�ment� of concrei;e curb and , ' guL-ter and a_nsL-al.l. a 3 foc�i: wide approac:h wiih •. ' . G.i.nch �3epth; Drivcway width plus G feeL- r. $17.85 � • � . ,...I�DJ�ITioN/�.� iNr-OR��nTior� �or the purpose of compt��:ing fees for building permits, the cubica]. conL-ents of any buildzng ar addition, is determined by rnuli:iplying L•he gr.ound azea covered fr.om a paa.nt si}: (6) inches beloca th� ,floor line Of {�i1L' baseme�it or t}ie cel].ar to ihe aver�ge heights ot trhe upper surface or i:o the average heiclhi: of ilze roaL-' sur�'ace of the raain gabl.e o� a pitched rooL. • Foa: re�airs or alterations to an existing structure� the �'ce shall be at the rate o� $3. 00 per each five hundred dollars �($500.00} or frac�ion ihereof in tlie cost of all proposed work. . • I31 'Y70 case sha].l the �'ee charged for an�= pennit as set torth �.n Sectian 2 be 1.ess � �Ildll $7.5Q }�lus $.50 staL-e surcharqe. � � Vf=RTFICATIQN OF FOl1i�DATIOf� NOTE: Permi�s £or consta.-uction ��i.11 be issued a riinimtnn of 24 hours fr.om tlze tvne oi application to allow for proper x'eview o� ihe proposed st�ucture a:�d of the . cons�ruction si�e. A Cer�i�Licate oi 5urvey of the lo�, shacaing the locai�ion of the toundation once it lias been constnicted will be rec�uired before pr.oceedi�ig wifih tiie iraminq. C�RT I F I CAT� OF OGGSlpANCY ' ngplica�.ion �or a CerL-i£icate oi Oceupaiicy shall be made L-en (10) days prior to the use or occupancy oi an� struci:ure �or wliicl� a� �iuildi.ng pca.�nlit lia� been assue3; 1I1C� s�id si-r.ucture sha�.�. »o� be used ox occupied u��.�il a. Certif5.cate of Occupancy has been issued. _ ..� . � , sue�aeT PERMIT City of Fridley 3 0 7 7 AT THE TOP OF TME TW�NS � � I L D i N G P E R M I T r ; � RECEI . � `v _.��_ COMMUNITY DEVELOPMENT DIV. �� r � � PROTECTIVE INSPECTION SEC. 1 . . � i �"'1 � CITY HALL fRIOLE� 5SIJ2 NUM9Ep pEV DATE PAGE Of A�PqOVED B� �""� � �'' 612-571-3450 gt0-Ft5 3/30/00 / / 108 AODRESS 5745 Jackson Street NE t LEGAI �OT NO. BLOCK TRACT Oii AODITION SEE ATTACNEO DESCii. 1S 5 Donnay's Lakeview Manor SNEET 2 PROPERTY OWNER MAIL ADDRES$ 21P PMONE Jim Jaeger 5745 Jackson Street NE 571-7880 3 CONTiiACTOR MAIL ADDRESS ZIP PMONE LICENSE NO P& J Siding 19420 Tri Oak Circle, East Bethel, MN 55091 434-0730 City a ARCNITECT OR DESIGNER MAIL ADORESS IIP PHONE LICENSE NO. 5 ENGINEER MAIL AODtiESS 21P PMONE LICENSE NO 8 USE OF BUILDING Residential 7 CIASS OF WORK O NEW O ADDITION O ALTERATION C� REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Repair fire damaged siding from garage fire 9 CHAN(3E OF USE FROM TO STIPULATIONS Call for building wrap inspection before covering. TYPE OF CONST OCCUPANCV GROUP OCCUPANCY LOAD SEPARATE PERMI7S ARE REOUIRED FOR ELECTI;ICAI, PLUMBING, MEATING. VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL ANO VOID IF WOiiK Ofi CfJNSTRUCTION 20NING SQ. FT CU FT AU7HORIZED IS NOT COMMENCEO V�IITHIN 80 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED Ofl ABANDONEO FOii A PERIOO OF 120 OAYS AT ANY TIME AF7ER WORK IS COMMENCED. NO DWLG. UNITS OFfSTREET PARKING I HEREBY CERTIfV THAT 1 NAVE READ AND EXAMINED TMIS APPLICA710N 1 STALLS GARAGES AND KNOW TME SAME TO BE TRUE ANO CORRECT. ALL PqOVISIONS Of LAWS VALUATION SURTAX AND ORDINANCES GOVERNING TMIS TVPE Of WORK WILL BE COMP�IEO , WITH WME7HEq S CIFIED HEREIN OR NOT. TNE GRANTING OF A PERMIT ��F�SOO �L.LS DOES NOT PRE E TO GIVE AUTHORITV TO VIOLATE OFi CANCEL THfi pEFMIT fEE SAC CHARGE PROVISIONS Y R S7ATE OR LOCAI LAW REGULATING CON- HU TION R E Rf qMANCE OF CONSTRUCTION XXXXX $111.25 Fire �4.5� PIAN CMECK FEE TOTAL F E �1 8.0� S�GN TuA OF .RACTOAOpAUTMOp�2EDeGENi iOAiE� N P OP LIDAT T IS IS UR ER IT � �. S�GNOTUAE O� OWNEQ�� ON�NEA BWLOHp� iO�fEi �=� � BLO �NSp qpiE � � NEV1/ [ ] ADDN [] ALTER [ ] Construction Address: �� Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMITAPPLICATION � � � �r � Effective 1/1/2000 (763) 572-3604 Bidg Insp �� p ��b Owner Name 8� ddress: � � e ��e� Tel. #� 7/` �� Contractor: �" � ^ � MN LICENSE # J � Address / c L%�-u �',�, � �5� � c'_' i'�� Tel. # G/,� �% -�73� LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT ° Length Vlfidth Height Sq. Ft Length Wdth Height Sq. Ft Hgt/Ground �_ Sq. Ft �� /� `�� Z- � ��C� Constnaction T e: i � � �' YP Estimated Cost: $ Driveway Curb Cut Width Needed: Ft + 6 F- Ft x$ _$ DATE: � .� C'� APPLICANT: Tel. # � S 7� � � � � CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ %�/. o?�,� Fee Schedule on Reverse Side Fire Surcharge $ ,S D .001 of Permit Valuation (1/10th%) State Surcharge $ � . �S{' $.50/$1,000 Valuation SAC Charge License Surcharge Driveway Escrow Erosion Control $ $1100 per SAC Unit � $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [] Not Necessary [] TOTAL $ � � , STIPULATIONS: �S' �� / ��e �� 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, 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 tawit: TOTAL VALUE $1 to $500 $501 to $2,000 $2,�1 to $25,0� $25,�1 to $50,000 $50,001 to $100,0� $100,(�1 to $500,000 $500,001 to $1,000,�0 $1,000,�1 and up FEES $23.50 $23 .50 for first $5(� plus $3.05 for each additional $100 or fraction thereof, 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 fraction thereof, to and including $SO,OQO $643.75 for first $50,0� plus $7.00 for each additional $1,�0 or fraction thereof, to and including $1Q0,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,0(}0 $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,(�0 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete C�rb Streets Only) Alternate "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 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. New Houses Onlv -- - . �