PRE 2010 DOCSCity ®f Fridley, Minn.
BUR DING PERMIT
Date: Oct Z 1968
Owner: Charles Johanson Builder
Address 580 69th Ave. N. E. Address
Same
Same
e , WY6
N° 9963
46� LOCATION OF BUILDING
No. _ Street _ Rice Creek Blvd. _ part of Lot
Lot _14 Block 1 Addition or Sub -Division — Holiday Hills
Corner Lot _ Inside Lot — X Setback 35' _ Sideyard 20'-35'
Sewer Elevation 8M0 Q8_ 823.08
Top of Footing
DESCRIPTION OF BUILDING
To be Used as:
Dwelling Front _L01 Depth 30' Height 20' Sq. Ft 1440 Cu. Ft. 28,800
Garage Front 26' Depth 24' Height 10' Sq. Ft 624 Cu. Ft. 6240
Type of ConstructionExame Est. Cost __ 30.09(L--- To be Completed
SEWER LOCATION - out of manhole at S. W. corner of the lot
WATER LOCATION - 76' West of Manhole in intersection , 108.6' S. E. of hydrant
In consideration of the issuance to me of a permit to const
the proposed work in accordance with the description above set
ordinances of the city of Fridley.
above I agree to do
r1tiy a'll provisions of
In consideration of the payment of a fee of 2 48 M 00 _, permit is hereby granted to Charles Johanson
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 said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Mlimesota reg location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Building Inspector
lisle
NOTICE:
11d9 permit does not cover the construction, hntaQatton for wiring, plumbing, gas heatteg, sower or water. Be acre to on
the Building Inspector for separate permits for these tinea.
APPLICATION FOR BUILDING PEEEIT
CITY Or, FRIDLEY, MINNESOTA
CHARLES E. JOHAN�
OWINM IS NAYIEL_0_# 4i, �-- BUILDER 5aQ_E91LAMen11P_N. L.
ADDRESS 580 69th Avenue N. L. ADDRESS Fridley, Minnesota 5543,'
Ffi Mipper
2.
G E 4
LOCATION OF BUILDING
NO. STREET,
LOT— BLOCK ADDITION OR SUBDIVISION ,z �""
COB -'\M LOT
INSIDE LOT d�
SETBACK ?5- SIDE -YARD -3
SEWER ELEVATION -TOP OF FOOTING.
Applicant attach to this form Two Certificates of Survey of Lot and
proposed building location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Front TO Depth Height,
Square feet Cubic Feet
a-,- Front f Depth I- I/ Height2_�__
Square feet
Cubic Feat
Typeof Construction -Estimated Cost- 36 0e.0 CO
To Be Completed
The undersigned hereby makes 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 Department of Buildings,
and hereby declares that all the facts and representations stated in
this application are true and correct.
DATE 62, (� / /�� 5 SIGNATURE -b,,�- C'
(Schedule of Fee Costs can be found on the Reverse Side.)
N9 4922
Original Permitr PLUMBING AND GAS FITTINGq7 ®CPQ
N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for Permit
�� • 0-c'inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit., ]Fee �
DFSCRUMON OF WORK II
Number, Kind and Location of Fixtures
Stories
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Basement
1st
2nd
3rd
4th
Connected with Sewer -Cesspool Cas Piping for 5E� Openings
Permission is hereby granted Q! — to do the plumbing and
gas fitting in the building described in the statedzent heret attached, upon the express condition that
the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing
or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and
this permit may be revoked at any time upon the violation of any of the provisions of said ordinances.
By Order Of The Inspector Of Buildings
Roughing in Inspection
Inspector.
Final Inspection Date
Inspector.
-a42 1M -6-65-v
City of Fridley ,19
Owner��'
Location
Kind of Building
Used-�-
To be Completed ,19
Estimated Cost
Old -New. Building Permit No. 92 6 3
Inspector of Buildings.
Application for Power Plants and Heating, Cooling, Ventilation. Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ...........................$10.00 $
Replacement of Furnace ............................. 6.00 $
Repairs & Alterations—up to $500.00 .................. 6.00 $
Repairs & Alterations each add. $500.00 ............... 3.00 $
MECH. WARM AIR
0
Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $_� o
each add. 60,000 BTU ....................... 3.00 $
Replacement of Furnace ............................. 6.00 $
Repairs & Alterations—up to $500.00 ................. 6.00 $
Repairs & Alterations each add. $500.00 .............. 3.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. 10.00 $
Each add. 200 sq. ft. EDR Steam ...................... 3.00 $
Each add. 320 sq. ft. EDR Hot Water ............... .. 3.00 $
OIL BURNER—to 3 gal. per hour ........................
6.00
$
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 199,000 BTU) .......................
5.00
$ 1099-0
over 199,000 BTU See Fee Schedule
GAS FITTING FEES:
NO RATE TOTAL
1st 3 Fixtures ......................
x$ 2.00
$
Additional Fixtures .................
x .75
$
Gas Range to 199,000 ...........
x$ 5.00
$
AIR CONDITIONING
$
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
$
ALTERATIONS & REPAIRS
TOTAL FEE
$
ROUGH
FINAL
Dept. of Bldgs. Phone 560-3450 ,p
Location 6 ✓�`+�
City of Fridley:
The undersigned hereby makes application for a permit for the work herein.
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley, All= PV 7 , 19 5�
Owner
Kind of Building ✓/��sJ�'te�
Used as
To be completed about
�®, ®®
Estimated Cast, $�®
ted—New. Building Permit No. "�' Permit No. ��gf
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No
Trade Name Size No
Capacity Sq. Ft. EE.D.RR`dBTU H.P.
Total Connected Load (� / � Kind of Fue
BURNER — Trade Name Size No
Capacity. Sq. Ft. EM -R BTU H.P.
(REMARKS—OVER)
Signed�_� l gO7
Byr
Business Phone
Original
PERMIT for Power ants and Heating. Cool-
ing, ventilation. Refrigeration and Air
Conditioning Systems and Devices
DESCRIPTION OF WORK
No. of % Heating Plants ^` C tJ to beta—altered—repaired
Make , Size ;
Oil fired—; Coal fired ; Gas fired x ; Gas ,Authorization No.
Remarks 7e'�
..
Approved
Final Inspection Date , 19..._
,Inspector
Permit o-9-911023—
Fee $ dz.� Na - 4596
Office of the Inspector of Buildings
City of Fridley
City of Fridley, Minn. .19-43
Owner
Location�
Kind of Building
How Occupied
Work to be Commenced—, 19—
To be Completed—, 19—
Estimated Cost, ° 6-e
Old -New, Building Permit No. 890/3
Permission is hereby granted
`'' ' " " " - —' to install—erect—use the material and devices described in the
to
above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work
done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley
relating to or governing the work to be done and the operation of the devices herein named, and to the specifications set forth in the approved application for this
permit on file in the office of the Inspector of Buildings. / ,Q
Inspector of Buildings
.11�42 2MII."V
E
NO. RATE TOTAL
all
x $2.00
$
Future Fixture Opening .... .... ......
x $1.5o
$
New Fixture Old Opening ......... ..
x $1.50
$
Catch Basin .. .. .. ... ......
x $3.25
$
Water Heater (Up to 99,000 BTU) ....
x $3.00
$
New Ground Run Old Bldg.
x $3.26
$
-IMIN
: $2.00
$
GAS FITTING FEES:
NON
1st 3 Fixtures ..........................
x $2.00
Additional Fixtures . ..................
x $ .75
$
No
1 x $5.00
$ 3.00
MEMENE
MOSINEE
IN
IN
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ...... ......
x $2.00
$
Future Fixture Opening .... .... ......
x $1.5o
$
New Fixture Old Opening ......... ..
x $1.50
$
Catch Basin .. .. .. ... ......
x $3.25
$
Water Heater (Up to 99,000 BTU) ....
x $3.00
$
New Ground Run Old Bldg.
x $3.26
$
Electric Water Heater
: $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..........................
x $2.00
Additional Fixtures . ..................
x $ .75
$
Gas Range to 199,000 BTU ..............
1 x $5.00
$ 3.00
REPAIRS & ALTERATIONS -Refer to Cods
Description ................................................$
TOTAL FEE ¢ 3.00
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct.
Fridley, Minn 7-11.-69 x,19_
. Owner James Grassman
Kind of Building Frame
Used as Res.
To be completed about _ 7-16-69
Estimated Cost, $ K. no
gNew. Building Permit No. Pe nnit m1
Signe
iIIIN pOL(S GAS
ROUGH
FINAL '
Business Phc,ne
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
i
Number Fixtures ...... .. ..........
�_ x $2.00
$ g
Future Fixture Opening .... ...........
x $1.50
Z
Z
x $1.50
$
Catch Basin .... .................
x $8.25
$
Water heater (Up to 99,000 BTU) ......
WATER HTR,
$
New Ground Run Old Bldg. . .........
x $8,25
$
Electric Water heater
: $2.00
S
GAS PITTING FEESt
NO. RATE TOTAL
1st 3 Fixtures ..........................
QQ
$ 22 80
Additional Fixtures . .......... :.......
—x$.75
$
F
N
GAS
EIEC.
E$
i
1�i
-
-
2nd
-
3rd
---
- --
4th
_
Com inings Connected) with
e Now Plzhm. Old Opo I meiCesspoo❑
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ...... .. ..........
�_ x $2.00
$ g
Future Fixture Opening .... ...........
x $1.50
$
New Fixture Old Opening ......... ..
x $1.50
$
Catch Basin .... .................
x $8.25
$
Water heater (Up to 99,000 BTU) ......
x $8.00
$
New Ground Run Old Bldg. . .........
x $8,25
$
Electric Water heater
: $2.00
S
GAS PITTING FEESt
NO. RATE TOTAL
1st 3 Fixtures ..........................
x $2.00
$ 22 80
Additional Fixtures . .......... :.......
—x$.75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
REPAIRS tt ALTERATIONS—Refer to Code
Description ......... $
TOTAL FFA s-231- o�)
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this applicatio are true and correct
dley, 19
_ Owner
Kind of Building LZ
_ s
Used as �.
To be completed about
Estimated Cost, $
OldNew. uilding Permit No v I permit MO. 4q
Signe
By
Business Phone
ROUGH
FINAL
4
SUBJECT
PERMIT NO.
City of Fridley
®1298'7
AT THE TOP OF THE TWINS
PERMIT
r
BUILDING
RECEIPT NO.
i
COMMUNITY DEVELOPMENT DIV.
yr -ry�
(pti%
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
�• 612-560-3450
910-F15
6-4-75
JOB ADDRESS
456 Rice Creek
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
SHEET
14
1
Holid-Ay
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
JAMES H. GRASSMAN 456 Rice Creek Boulevard,
dlay, Minnp-.-,nta
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Custom
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
SWIMMING POOL
7 CLASS OF WORK
NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
CONSTRUCT SWIMMING POOL 18 x 36
9 CHANGE OF USE FROM TO
STIPULATIONS
SEE LETTER OF JUNE 4, 1975
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Alum. Vinyl
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
R-1
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,
$8,000
$3.00
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-
STROCTION 0 ERFORMANCE OF CONSTRUCTION.
�yb'
XII $48.00
PLAN CHECK FEE
TOTALFEE
$51.00
GNA RE FCONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERL,y VALIDAT D THIS IS YOUR PERMIT
Lcn4 4
BLDG INS P
June 4, 1975
DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) - (DATE)
' KATION FOR RESIDENTIAL., ALTERATION,
�..I OR ADDITION.BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
�--
OWNER'S NAME:� .� BUILDER: r
A M
bi /�►
ADD1zEss :rS A»aEss :
NO:. STREET:.
:.OT : BLOCK.* ADDITION
CORNER LOT: INSIDE LOT:SETBAGK:
ARD:
Applicant attacka this .form Two Certificates of Survey . of. Lot and .proposed
building location drawn on these Certificates;
DESCRIPTION OF BUILDING
To Be Used As: ax
esl CJ /Front: Depth: Height:
Square Feet: Cubic -Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: I �ey_—Estimated Cost: $ ®®®'
To Be Completed: ig r a
The undersigned hereby makes applicati-on 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 Department. of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE: !� �'�' SIGNATURE .
ti
(See reverse Side For Additional. Information.)"
y,F
15 WwZV_ff9,)
INA g�
June 4, 1975
Custom Pools
701 E. Excelsior Avenue
U Hopkins, Minnesota 55343
I?
C Re: Swixming Pool at 456 Rice Creek Boulevard
LO
N
Gentlemen:
N
This letter is to reiterate my conversation with Mr. Tim
Hannan
of Custom Pools on June 14, 1975 and to make clear
LO
LO
this department's requirements for the swimming pool construction
Q
F-
at the
above address:
O
N
LU
1
1.
As discussed, two (2) skimmers approved by the National
z
Sanitation Foundation will be provided.
5i
2.
As discussed, four (4) inlets of approved design for
y;
fresh and/or repurified water will be provided.
LU
3.
As discussed, a main drain of approved construction
0
will be provided.
LL
4.
The filter and pump shall be approved by the N.S.F.
®
and be of sufficient capacity to provide a minimum
turnover of at least two (2) times in 24 hours.
Q
This department recommends a turnover rate of 6-8
hours.
cc
5.
A deck, a minimum of 3 feet wide and sloped away from
O
the pool must be provided around the entire perimeter
Z
of the pool.
LU
D
6.
The diving area will be acceptable provided there is no
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w
overhead obstruction.
>
Q
7.
A fence or other suitable barrier, a minimum of four (4)
feet high, that affords no external hand or foot holds
and which is impenetrable by toddlers, must be provided
a
around the entire perimeter of the pool. All gates and
>
other accesses shall be equipped with self-closing and
z
latching devices which are capable of being locked.
8.
An automatic chlorinator should be provided with a
Sad
suitable test kit.
CO
9.
All electrical and plumbing installations shall be
inspected and approved by the City Inspection Department.
10.
All electrical lines must be 10-20 feet or more away
z
from the pool surface.
v
11.
The pool fill spout must be air gapped or protected by
U a vacuum breaker.
SWIMMING POOL
456 RICE CREEK BOULEVARD
PAGE 2
AV 12. Suitable safety equipment to include but not limited
to a ring buoy and rope that is 13� times the pool
diameter, shepards crook pole, must be provided and
maintained with the pool at all times.
Furthermore, these and any other requirements must meet -.the
provisions of the Fridley City Code, Section 115, Swimming Pools.
The building permit is approved contingent on final inspections
and approval by the:iEity.
If any questions or problems arise from this letter, please
feel free to contact me at 571-3450, Ext. 41.
SJO/cs
cc: Mr. James H. Grassman
456 Rice Creek Boulevard
Fridley, Minnesota 55432
Sincerely,
4-1t
'J� )7e�k
ST N J O' ON
Environmental Officer
r�
11
SUBJECT
-
City of Fraley
=,�
AT THE TOP OF THE TWINS
BUILDING PERMIT
f
R CEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
® I
1
(---• A CITY HALL FRIOLEY 55432
NUMBER
REV
DATE
PAGE OF
AO -PROVED 8Y
,��"',';
L J` 612-571-3450
9tq-F15
10/25/01
JOB ADDRESS 456 Rice Creek Blvd NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
14
1
Holiday Hills SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Richard Johnston 456 Rice Creek Blvd NE 763-571-2792
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Showcase Builders Inc 16026 Lakeshore Dr, Eden Prairie, MN 55347 952-934-1490
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
20078380
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW 0 ADDITION O ALTERATION Cj REPAIR 0 MOVE O REMOVE
8 DESCRIBE WORK
Reside House & Garage; Replace Windows Within Existing Openings
9 CHANGE OF USE FROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather
resistive barrier be placed over exterior sheathing to protect the interior
wall covering. Exceptions for this provision would be if sheathing is an
approved weatherproof panel or when the siding is an approved weather
barrier. Vinyl siding is not a weatherproof covering unless the manufacturer
states this in their application guidelines. Call for inspection of wrap
before covering.
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk
and flash all exterior openings.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING. HEATING.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. 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
1
ISTALLS 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
r
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$15,830
$7.91
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER OR LOCAL LAW REGULATING CON.
TRUCTION O THE PERFO A OF CONSTRUCTION
$265.25
Fire SC $15.83
E
PLAN CHECK FEE
TOTALFEE
Li nse SC $
$293.99
"GNATURE OF CON'RA(IOR%QR AUTHORIZED AGENT (DATE,
WHEN PROVALIDATED THIS IS YOUR PERMIT
BLDG �NS� r�ATETE
S-GNATURE OF OWNEROF OWNER BUILDER, iDATE,
r�
11
NEW [ J Effective 1/1/2001
ADDN [ J CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: S^ 1 �� ��- V1
Legal Description:
Owner Name "ddress: Y`S Tel. # �6-2"-S
Contractor: �c3�c-� \ 1Nl�MN LICENSE #Ci i
Address: i (,pC) -2�, �--�Jr -- � Y. ��r�`� r c ,_Tel. # 9 s z - f 3 Lf -/ y5(J'
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 Width Height Sq. Ft.
Length I Width
Length Width
Height Sq. Ft.
Hgt/Ground Sq. Ft.
Construction Type: ��� `moi UA'v� C-lus- Estimated Cost: $ i
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: /U �'-(?I APPLICANT: "'Z Tel. #
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ c2&�7o25! Fee Schedule on Reverse Side
$ l� .001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$ $1150 per SAC Unit
$ ® U $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 [ ]
a 3.99