AF - 47759: '1 `� ' -�_ �� . I�
Village of ��idley, 1Vlin.n. N� 2 3 8 8
�
Date ,� r�. �. :�. � . .�� . . . . . . . . . . . . . . . . . . . . . . . . . . .
Owner� �' • • � ��.� Builder ,�?�`.`'.�:'r�.�^'� . . . . . . . . . . . . . . . . . . . . . . . . . . . .
� �� .�"'r,�. ":�-�;;=z,c.f.� �
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Address �� �: � . . . �:�:s�-�'aG�.�k����' Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
� .
, LOCATIORI OF BUILDiN�G
�
No. .�?.�`�'.��........ Street`..�'�'��C�.f�E�"�.._�+.�,�'�i�'.+....... Part of Lot .......................
Lot . . . :.��. . . .. . . . . . Block :� . . . � . . . . . Addition or Sub-Division . ����`�'. . L,.: :�' "� . ,�, ,�.�
• � �,� �
Corner Lot . �S : . . . . . . . Inside Lot . . �':�. . . . . . . Setback ,�:au�*�i/�. . . Sideyard � ..�'�'��� , . . , , , ,
DES�CRIPiIO1V OF BUILD6NG
To be Used as:
� ` �.
>� ,,,;���� ..... Front �,��.'.'".� Depth �:':. I-ieight %��, �r.. .. Sq. Ft. ��4� Cu. Ft. ........
.................... Front ........ Depth ........ Height ......... Sq. Ft. ........ Cu. Ft. ........
Type of Construction �:���e��.. Est Cos��,+'��.�:� :�.'�....... To be Completed �' .. ��'�e�,���'"��..
�
In consideration of the issuance to me of a permit to construct the building described above, t agree to do
e the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the village of Fridley.
...................................................
�� In considerat�p�n. of the payment of a fee of $. ��,� ., permit is hereby granted to °."��;��
r,�'s ��i�:. .. �'� _. to construct the buildin or addition as described above. This ermit is
tYie express condi�t'�on t�,hat the person to whom it is p S'�' ed upon
granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
P'ridley, M'umesota. regardiag location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon�violat�ion of any of the provisions of said
ordinances. � _
=-�6`�C'."°�� '_'_���+'�` �i�`r :r .. Bu�lding Insgector
��.� .� : .
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NOTICE:
This permYt does not cover the construction, installatlore or alferation for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permtts for these items.
�
�
Date:
C��:� ��
.,, .
���.
City of Fridley, Minn.
��
BUII.DING PERM[T N° 3 4 0 0
....1:...�.%".�:�:.�........ ,��_
.�'� .��� �. ......?°L. Builder ....� ...................................
. . . ..... ...
R`�"� .�i•���%...�• . ..�.�� Address .............................................
LO�ATION OF BUILDING
No. t�. �K .�. . . Street . . . . . �0.Q'yl . . , ��. . . . . �Part of Lot . . . . . . . . . . . . . . .
Lot . � . . . . . . . Btock . . . . . . . . �. . . . . . Additlon or Sub-Division �/l�t� .1.��� • •' •'Ee�R�►d/.�rlrfi� 7'
Carner Lot ............ Inside Lot ............ Setback ............ Sideyard ...........................
DESCRIPTION O� BUILDING
To be Used as: r r• ��
� . . � �'.Q � � � `/ � �a x� t �' 4
� � / °� � � . Cu. Ft. .':��. : . . � �o
.e� . . . . . . DePtt► . . . . . � . a , gh . . . . . . Sq. Ft. �. . . --'
/.��?-�. . . . . . . . r�rom �.� : � neprn . s� : : : .C� xe�gnt l(� ' � sQ. Ft. l �? Q. . cu. �. .,��a � �� `*3`
. . . . . . . . . . �. c�. . . .��. . . :�� �.
Type of Construct3on ......... ..... To be Completed ..............:....
r���� %�.� / /�" (P�i � P v \ (1
, � ���► "�
� 7 �'� � f�e
�- �,
�
In consideration of tihe iss�uance to me of a permit to canstruct the bwilding desribed above, I agree to do
the proposed work fn accordance with the description above set forth and in compliagce wi a11 provisions of
ordinances of the dty of Fridley. ; �
� �,
�%. . .�4-'� . ,. ;,��.. : �zc..��� .
/ �
--
In consideration of the payment of a fee of $�l.� .'�.':., permit
gzanted to ...................
..... .... ........ ... ..... to construct the building or addition as descrlbed above. This permit is granted upon
� the express condition that the person to whom it is granted and ��ia 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 location, construction, atteratlon, maintenance, repair and moving of bufldings with-
fn the dty limits and this permit may be revoked at any time upon violatfon oE any of the provisions oP said
ordinances. � � .: -�
:� ��j�.d/. . :': `.7. . . . �,,. Builrling Inspector
NOTICE:
Thla pe�mlt does not cove� the construotlon, installatlon or alteration fo� wi�ing, plumbing, gaa heating,
sewe� or wate�. Be su�e to eee tha Building Inspeoto� fo� sepa�ate permtte fo� these Iterr�s
----��\
.�
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�'�1
City of Fridley, in�n
BUILDING PERMIT
Da�: OCTOBER 5, 1965
,����- �
N� 8509
�: ZEE ANDERSOIV 8�� ROBERT F. NORBERG
Ad�re� 6800 Jeffersoa St. N. E. Ad� 3924 Utah Avenue North
Fridley 32, Minnesota Minneapolis, Minnesota
LOCATION OF BUILDING
No. 680Q s�t Jefferson St. N. E. p� of Lot
Lot 3 _ Slock 1 Addition or Sub-Division Rice Creek Terrace, Plat 4
Coraer Lot — Inside Lot Setback Sideyard
3ewer IIevat4on _ - ----- Foundation IIevat3on
To � v�a �:
Type of Construct4on
DESCRIPTION OF BUILDING
�t ne�n A��t sn. r-�t.
Front Depth FTefght S�l. Ft
�, � _�fi��500.00 To be Campleted
c;u. r-ti
cw �t.
REBIIILD TORNADO DAMAGID HOME
In c�deratton of the 3ssuaace to me oP a perrnit
tha proposed work in accordance wlth the d�ecription �
ordinances of the dty of Fr1a11ey.
�
uct the bufldfng described above I agree to do
forth and in compliauce with a'il pravisfons oP
> � _ // t
In ca�aideration oP the payment oY a Pee of $1Q..DD �°'permft fs hereby granted to ROBERT F�
NORBERG to conatruct the bt�ilding or adclitfon as descrfbed above. Thisp�rmi t is �ranted up�
the exAress con�iitlon that thepers�n to whom it ie �anted and hfs agente, employees anc� worl�nen� ffi all work.
done in, araund aad upon eaid buildfng, or an,q thereof� shall �nforan fn all resPects to the ordinsnces oE
Friclley� Minnesota ar�ia� lacatlon� conatru� alteration, matatenaacre, repa4r and moving of build9u�s
wi�� city ]imfts�3and th�s permit may be revoked at any tirne upoa violatioa of aay o4 the provi�lona og eatd
ALLEN G. JENSEN H�1�8 ��
NOTICEa
71d� p�emtr doa ne1 aovu d» eoetlroaH�, IeeallNiee hr vrWaY. P�mR� Ya 6�aNea, ww�r e� wat�r. B� sms to a� /�
�In Btdidloe le�� ier apa►af� p�emht fo� f6�a k�. �
.�. /.
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APPLICATION FOR BIITLDING PERMIT
CIZ`Y OF FRIIILEY, MINNESOTA
�j � / �j
OWNER' S NAME ��'� �''i/�f'�'�� /� �r° �' BOILDER � � !� c= .�° f �°. /9l �:� �i � .�-�
ADDRESS �' � �° � �� � �
�C���=F_ /�i S�9r�.o ADDRE5S � j� y C�t<�� � c�� %1/„
LOCATION OF BUII.DZDiG
N0. ����C� STREET V�'��'� s�s'6'�'� S� PART OF LOT
� �t a ��� 1�
L� � BLOCR � ADDITION OR SIIBDIVISIUN � c� �° C�"t'�'�°� ' c� j7;
CORNER LOT INSZDE LOT � SETBACR SIDE YARD
SEWER �LEVA`1'i0N - FOUNDATION ELEVATIOP
Applicant attach to this form Two Certificates of Surveq of Lot and propoaed
building location drawn on these Certificates.
DESCRI�'TION OF BIIILDING
To be used as: �,��: �� ����1a�,�^ �/���.��f�-� c�,�7�
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction ��[""�;��L- �-�VOyc�j-� Eatimated Cost �� `S ���, o n
To be completed �✓ �t � � / ���
The undersigned hereby makea application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Departmeat of Buildings, and hereby
declares tha.t all the facts and repreaentationa stated in this application
are true and correct. _
, �
DATE_ ��`'7c�i� c��- �S; J j( � SIGNATURE � ���
(Schedule of Fee Coats can be found on the Reverse Side).
y �
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( I
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BUII�DIl�G PERMIT FEE ' SCHEDIILE
SECTION 2. The Inspector of Buildings shall, before iseuiag any permit for�
the erection of any building. or ats`ucture, or� for at�y addition to any .existin�
building or atructure, or for any alteratione or repairs to any existing
building or structure,_upan application therefore, require the paymeat by the
applicant for such periait of fees to the amount"hare3n b.e1Qw set �arth and in
the manner herein provided to•�vit;
2.1. For any euch permit for the erection of any fire-proof building,
othe= tha a garage, warehouee, factory or�graia elevator, or for the erection
of any fire-proof addition, for similar occupancy, to any esieting building,
aha11 be at the xate of $1.40 for each aae thousand cubic feet, or fraction
thereof, in �uch cubical contenta.
2.2 Far any auch permit for the erection of any fire-proaf garage,
�rehouse,�factory or grain elevator, or for the erection of anq fire•proof
addition, for aimilar occupancy, to any exiating building ahall be at the .
rate�of $1.25 for each one thousand cubic feet, clasaffied as "fireproof"
by Section 502 of the Minneapolie Buildiag Code. �
SOIISES
2.3. For any auch permit for the ere�tion of any non-fireproof
building, other than a garage, warehouse, factory or grain elevator, or
any non-fireproof addition, for ei.milar.occu�ancy, to any existing bui�,diag -.
permit $1.00 for each one thousand cubic feet. ,.
GARAGES
2.4. For anq auch permit for the erection of anq non-fireproof garage,
warehouse, factory or grain�elevator, or for the erect�.on of any non-fire-proof
addition, for similar occupancq, to any esisting buildiag or for each such
building or addition - ninety centa ($0.90) for each one thous.and cubic feet
or fraceioa thereof, in the cubical contents thereof with the minimum of $4.00.
For the purpose of camputin� fees for building permita, the cubical contents
of any building or addition to a uniform height throughout by multiplying the
grouad area covered fram a poin� six (6) iaches balow the #loor 7.ine of �a�e
basemeat or cellar to the average h��ght of the upper aurface or Co the average
height of the roof surface of.the main gable of a pitched roof.
2.5. For repa3rs or.alterations to an esisting at*urr.«re, the fee sha11:
__
be at the rate of �3.00 per each Five Hundred Dollars ($5���.G�j or fraction
thereof in the cost of all propoaed work.
2.6. In no case ehall the fee charged for any permit as set forth in
Section 2 be less than $4.00.
STORM REPAIR DAMAGE FF�'S:
Residential;
Commercial;
• M
Est�:n•^red Cost of work up to $5�0.00 -$S.�JO
Ar fa'j
Es `i�.�ed Cost of wo�k over ;:.�-��, ��J - � G�o i10
w_+ .ti4
E��im.�ted�ost of war.lc u.p to ye('7. �0 -$IC�O
Estimtsted ,oat of worie over $5��i.00 -$�(. J
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I�'AT LOSS CALCtJLATIONS DEPARTMENT
�,eat6ersG!ips � Conatruetioa 11'
Guide
Window�,�� Doon Refamce Ou��Wall Ia� Wall Ce�7inq
Yes—��IVo I Yes—No 19_
Fl.� Room Length � Width Heigi�t
Rlindows and Doora--Gackage aad Area .
\YIAtd HN�et Na ot La�a1 tL An� •- _--
Na o[ pae� ol D�ae Ilibq o! craek p. ft
� ,� � ��' a �J
� � �'r �- �s �- 7 5�v '
� a �a �
� � v /�o � � y� Coef. Bcn
In6ltratioa
Class
Fsp. wall
Nec e :p, waU �
IaG wall �
Ceiliag
F1oor -
Total Btu.
Reyuired sq. k. E.D.R. or sq. ias. W.A. Leader area
Fl.� Room Length Width Heighc
•Windowa aad Doors---Crackage and Area �
Wldth Hal�pt No. ot Ltn�al t4 Ara
Na ot Drna ot y�ae U�h4 et er�alc p. tL
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Ia6ltratioa �� /�j 7
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Net e:p. wall
Iat. wall
Ceiling
Floor
Total Btu.
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Fl. Room � L.ength Qlidtl:
Wiadows and-Doors—Crael�ge aad Area
Width H�Itet No. at I.la��l tt. Area
Na ot uan• o[ pan� ll�bti o[ eraek ra. fL
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Net esp. waU
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Total Btu.
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OF INSPECTION NmVNEpppL1S� ll�
'o. Iosolation
Root Floor Kinds Fj�,,► Applied
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wia�n adsee xa ot �rn.a ca n..a __ _
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Floar
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Fl.I Room I Lrenech Width Haei,c —
Windowa and Doors--Gaekage and Arca
WIQt6 Hal�bt• No. ot Lln�al [t Am
Na ot �aa� et paa� Ilsbts ot craalt p, t6
In6ltratioa
Glau
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Net ezp. wall
Int. wall
Ceiling
�oor
Total Btu.
Required aq. ft. E.D.R. or sq. ins. WA. Leader area
Fl. ' Room 1 L.ength Widch
RI'mdows aad Doors—Craekage and Area
Wldtl► HNSOt Na ot Llaql tt An�
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Net e�. wail
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SUBJECT IT NO.
City of Fridley � � :� �� � 4
AT THE TOP OF THE TWINS gU I L D I N G P E R M T
r
� � RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
� ; L ----- . �lg�
r � � PROTECTIVE INSPECTION SEC.
� . �
l----�; ����;.� CITY HALL FRIDLE� 55432 NUMBER AEV DATE PAGE OF APPqOVEO B�
L 612-571-3450 910-F15 10/25/96 / /
JOB ADDRESS 6800 Jefferson Street NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3 1 Rice Creek Terrace Plat 4 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Joan Anderson 6800 Jefferson Street NE 571-3668
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO.
Panelcraft of MN 3118 Snellin Ave S, M ls MN 55406 721-6628 2179
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZtP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP pHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION O ALTERATION ❑ REPAIR � MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 20' x 11' Addition
9 CHANGE OF USE FqOM TO
STIPULATIONS
See notations on plan.
WA���NC
Before digging call far
ail ufiliry locations
SEPARATE P�RMITS REQt�i{� REQUIRED OBY L
WtR16VG, H�qTt�U� � F0� AU�
. PL111�76o1y� qND SI�NS.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAD
SEPAFATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT CU. F7.
AUTHOiiIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFfSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORHECT. 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 ��F� IOO �L.OS
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 TH ORMANCE OF CONSTRUCTION. �99.7.5 Fire aS�.' �4. 1�
1 PLAN CHECK FEE TOTAL PEE
� ✓�--� Lic se SC $5.00 $110.90
SI ATUAEOFCON�AACTOAORAUTNOAIZEDAGENT IDATE� HEN PROPEfiIY VA D HIS IS YOUR PERMIT
�
SiGNaTU�iEO%pWNEF7�iFOWNERBUILDEfii iDATEi BLDG �N A� ��h7E
iv 1,Yv
n��N
AL"I'Llt
I I � �./Q��[
�, . CI'I'Y Or CRIDL�Y
I I S1NGI_C rAM1LY ANll llU('LCX�S R-1 AND R-2
Builctinb Permit Applicatic�n
Cc�nstruction Aciclress:
Lebdl Descri�tion:
LII�CUvC ll ll J4
��97
Owner Nam • ciclrc;ss: . ���� �- � G, v7 Tel. �l � ,�� _ ��
Ccmtrucic�r: �� � � -i MN LICL'sNSC //
.�...�?..���_�..�...�r�-�- _ � � -------
,
Adclress:__ �<��� � %%e ��i f � �-� ��.� � ,� Tel. /l ����'����
LIVING ARC/i:
GARAG� ARCA:
llCCK ARrA:
OTI-I�R:
Attach to this a�plicadon, a Certificate of Survey of the
lot, witli the proposed conslruction drawn c�n it to scale.
DCSCRIPTI�N Or IMPROV�M�NT
Length Width Height Sy. rt.
Length Wiclth I-ieibht Sq. rt:
Length Width HbdGrounci Sq. rt.
r� � �� �L�'P,1��
Cc�rner Lc�t j � Insicle Lot ( � Pt. Yd S�tback Side Yard Setbacks
TY�e oi' Cc�nstruclion: (` ,o�C�1�sl ��:� Estimated Cost: $ �!����?��C%
A��rox, Com�lelion Datc;: �
(Cost on .Back)
Urive�vay Curb Cul Wicllh Neeclecl: rl. -t- G 1�t = lit x$ __$ _
llA"f�: ���1�1�' APPLICANT: �� 1 c�, li1 �. i e n c �� ��� �' Tel. �/ �.�f ��,��ri .,
Pcr�nit �ee
Pire Surchar�;e
SGitc Surcharbe
SAC Cl�ara;e
Liccnsc Surcharbe
Driveway �scc•c�w
�rosion Control
Park ree
Sewcr Mtti�i Cl�;u-�;c
•roTn►�
STIPULATIONS:
��,��
�__ �v
, �'
�_�2, a� _
,�
$_—�'_
�
$
$
$
��d•'�
CITY t)S� QI�Y
ree Scl�edule on Reverse Sidc
.001 of Permil Valuation (1/ 101h l)
$.50/$1,000 Valuation
$800 ��cr SAC Unit
$5.00 (State Licensecl Resiclential Conlractors)
Alt. "A" oc Alt. "B" Ahove
$450.(}0 Conservation Plan Review
�ee Determinecl by �n�;ineerin�
A�;rccmcnt Neccss.try I I Nc�l NcccssarY I I
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AT THE TOP OF THE TWINS gU I L D I N G P E R M I T
r
� � RECEIPT NO.
� ; y �_�__ COMMUNITY OEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. /b�' �j /�
1 . � `%"'yU
� � /"'1 � CITY HALL fRIDLEv $S43P NUAABEN REV DATE PAGE Of APPROVED BY
�""'"� � ,�� 612-571-3460 910-F15 9 / 11 / 98 / /
JOB ADDRESS 6800 Jefferson St
i LEGAL LOT NO. BLOCK TRACT OA AODITION SEE ATTACHED
DESCR. 3 1 Rice Creek Terrace - Plat 4 SHEET
2 PFOPERTY OWNER MAIL AODRESS ZIP PHONE
Joan Anderson Same
3 CONTRACTOR MAIL ADDRESS 21P PFIONE LICENSE NO.
Advance Aluminum Su 1 Inc 7701 Ma.in St NE Fridle 5 43
A ARCHITECT OR DESIGNER MAIL ADDpESS 21P PMONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PNONE UCENSE NO.
B USE OF BUIIDING .
Residential
7 CLASS OF WOFK
❑ NEW ❑ ADDITION O ALTERATION �7 REPAIR p MOVE D REMOVE
8 DESCRIBE WORK
Reroof house & garage (25SQ) Tear-of�; �rim
9 CHANOE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
e
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, NEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING. •
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GAfiAGES
ANO KNOW THE SAME TO BE TRUE AN� CORREC7. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOYERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHEF SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �3� 142.00 �I.S7
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERMIT FEE SAC CNARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCT OR THE PE ORMANCE OF CONSTRUCTION �8�. ZS Fire . C$3. L�F
PLAN CMECK FEE TOTA� E
• =v�_ Lic SC $5.0 $96.96
SIG TUpE Oi CON' ACTOR OR AUTMOAIIED AGENT IOATE� N P OP IDAT `IS IS PER I
�,
� �
SiGN4TURE OF OWNEfi Uf OWNER BWLDERi iDATEi NSP ryqTE
M- �
rrEw
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: � ��U �,E,��,�'.�S��v
Legal Description:
Effective 1/1/98
P � ��
� �
Owner Name & Address: ,TD�-•- /����s ��-.� Tel. # `
Contractor: �g,t���.�.�� „��.��, �,�-'voi��,r �iu._ MN LICENSE #�% � 3
Address: �� D/ �',�i�e �+.- � i s` y �C�/r�c��� Tel. # S�/°- ��'yO
�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
-� .�— � . / � i, �- _
�.�..��
Sq. Ft.
Sq. Ft.
Sq. Ft.
� 044
/�� .� ������ �/ � �o v� �l �/� —
Construction Type:_��� �,��� v,� �� r� Estimated Cost: $_ � Q D �/�a
�G� (Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � /�' �� �! APPLICANT: a t � Tel. � /f ` 3 y �0
�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ v % �.�
$ .��
$ /, Sr%
$
$ .S, C�
$
$
$
$
$ Wr9Y
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$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 [ ]
� _„ _
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 $2,000
$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,OQ0 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,OQ0 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.
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 the foundation once it has it has been constructed
will be required before proceeding with the framing.
., Q �