UntitledCity of Fridley, 8291
i
Date: July At 1965
Owner: Builder H F Construction Coo
Address Address 3936 Webster Agd.
St. Louis Park, Minnesota
LOCATION OF BUILDING
No. 4881 Street MAIN STRMT N. E. Part of Lot
Lot 2,9 1 30 Block 4 Addition or Sub -Division Plymouth. — AnokaCounty
Corner Lot _ I Inside Lot Setback 35 t Sideyard 101 3
Sewer Mevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Single Fly 1?wrl Front38,67 . Depth 2.6 Height 20 Sq. Ft 1O0Cu. Ft 20.100
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Wood Frame Est. Coat X10,000.00 To be Completed 90 daps
New Douse
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 compliance with ail provisions of
ordinanc:ea of the city of Fridley.
In consideration of the payment of a fee of $ 21.00 permit is hereby granted to & F CONST. CO.
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, Minnesotalocation, this permit
may be revoked t a time upon violationot any of the provisions ofand moving of said
orrdinanc fes. city limits and
Ai.TM Ca . JNNSM Building Inspector
NOTICE:
ihh peeach dos not offer the conatrfatioe, fartaitation for WhIm pwMbiss, on heating, "WW or water. Bon sin to see
the BfNh* MWeeter for soparate pwndit for than hens.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME BUILDER �� N-5
ADDRESS ADDRESS � , ��% uj'eF o. _
LOCATION OF BUILDING iS /0"9 /rK'
"� i,
N0, STREET - ! ? PART OF LOT
LOT o7 ? BLOCK. ADDITION OR SUBbIVISION77
/ d'
CORNER LOT VINSIDE LOT SETBACK/ SIDE YARD�/��
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as;
�/hiLil �Alrli��/ �hJr�rN� Front M, 2 Depth�2� Height C7
Sq. Ft. Cu. Ft. 2 ')
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction -469a 22 FTA ,ryas Estimated Cost®
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 SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side). A ���
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
Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $
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 $ m ,/
over 199,000 BTU See Fee Schedule
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures .....fit✓
............... x$ 2.00 $
Additional Fixtures x .75 $
Gas Range to 199,000 ........... x$ 5.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
$
See Fee Schedule
�— -�
TOTAL FEE
Dept. of Bldgs. Phone 560-3450
Location 4 z
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, Minn al 1.?
Owner & .
Kind of Building
Used as
J
To be completed about ;�/Z,6 fl
Estimated Cost, $
W --New. Building Permit No. Permit No. --*Ie 7:7
DESCRIPTION OF WORN
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No
Trade Name Size No
Capacity. Sq. Ft. E.D.R BTU H.P.
Total Connected Load Kind of Fue
BURNER —Trade Name°` Size NO-1� S -ft Sq. FL E.D.R- BTU H.P.
(REMARKS -OVER)
i
Date: July 23, 1968
Owner: Lee V. Johnson
Builder
Gorco Const. Co.
No
LOCATION OF BUILDING
No. 4881 Street Main st N. E. Part of Lot
Lot 29, 30__ Block —_4 _ _ Addition or Sub -Division _____ Flymu -
Corner Lot _ Inside Lot — Setback ___ Sideyard —
Sewer Elevation
To be Used as:
Foundation Elevation
DESCRIPTION OF BUILDING
�Z3
9840
Gagagg Front ?41 Depth 241 _ Height 10' Sq. Ft. -Uk— Cu. Ft _ 576
Front Depth Height _ Sq. Ft. Cu. Ft.
Type of Construction Frame Est. Cost _ $1950.00 ---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 ZI provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 9. 00, permit is hereby granted to Gorco Const. Co.
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 3n all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenaace, repair and moving of buildings
within the dty limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
El
Breher
Official
Building WIFAW
NOTICE:
This permit does not cover the construction, installation for wiring, plumhing, gas heating, sower or water. Be sure to see
the Building Inspector for separate permits for these Items.
APPLICATION FOR BUILDIENG PERMIT
CITY OF FR?DLEY, MUMSOTA,
OWNER' -9 iE_BUILDERL L:.----------.
AWRESS_ � ?1�er _ ADDRESS
LOCATION OF BUILDING
N0.
SOT BLOCK ADDITION OR SUBDIVISION
CORIMR LOT MSIDE LOT SETBACR'`SIDEYARD
SEWER ELEVATION s .,TOP Oe FOOT4NG-
Applicant attach to :tihis form' Tw' ,a 6ertli-i6ates of S'urvdy of Lct: and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING,;
To Be Used As;
Front �� Dep h+ t3aight_01-
SgUaite ' feet Silo Cubic Feet O
Front Depth Height
Square feet Cubic Feet
Type of Construction�IdIdda2iele Estimated Cost_„
To Be Completed C — ;2,3 w a
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 SIGNATURE
_SIGNATURE4�_(Schedule of Fee Costs can be found oa the R ver)
---
k
53-811=8915051
CH -j 1 Fridley
Applicatlan for S'lamling and M12'i13 i
Dept. of Bldgs. Phone 500.3450 -
DESCRIPTION OF G1011w Lota'�^"��4��1 M%ia �
Numb -or, Kind and Locrlien of Fixtures S°t ®Gt NE
PARTIAL RATE SCHIMULE
.UMBING FIXTURE RATES:
s
Number Fixtures ................
Sy
$
Future Fixture Opening ............
x $1.50
z k
of
c= IV
O
V
2
N
WATER HTR.
GAS
MC.
New Ground Run Old Bldg.........
x $.3.25
$
Eloetrir Water Heater ..............
z $2.00
$
FITTING FEES:
NO. RATE TOTAL
Ist 3 Fixtures ............ • • • • • •
x $2.00
< 3 v s
u a
o
$
,
Gas Range to 199.000 BTU ...........
x $5.00
:t
ir —stall
Wai
-m I lorrIng
SP
ce
He
to
3
3
H+
Future Cohnactl.:a
Connactod uritis
Sesser []
H41- Fixture, Old Opsnings
Ccr--pool []
PARTIAL RATE SCHIMULE
.UMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ................
x $2.00
$
Future Fixture Opening ............
x $1.50
$ _.
New Fixture Old Opening..........
x $1.50
$—;__
Catch Basin ....................
x $3.25
$
Water Beater 'Up to 99,000 BTU).
x $3.00
$
New Ground Run Old Bldg.........
x $.3.25
$
Eloetrir Water Heater ..............
z $2.00
$
FITTING FEES:
NO. RATE TOTAL
Ist 3 Fixtures ............ • • • • • •
x $2.00
$ .
Additional Fixtures ................
x $ .75
$
,
Gas Range to 199.000 BTU ...........
x $5.00
6
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 applicatson are true and correct,
Fridley, Mnn 1®21-76 18.
Owner a a mes Furlong
Kind of Building Frames
Used as Res.
To be completed about 1-28176 _
Estimated Cost,. $ 10.00
Old --NV+. Building Permit No. P®rmit No. C
Signed 92 99-1
By . _..
Business Phone NoMINNEGASCO
ROUGH
FINAL Z —C k - ?
v
S & ALTERATIONS—Rafer to Cod* .50 State Surcharge
Dexription....eSP��Q.Hi����.................. o.... 6.5D
TOTAL FEE S-7. 00 Class "A" Surcharge .56g
CITY OF FRIDLEY INSPECTION DIViSION
Effective On January 1, 1998
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS 4�?/
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work herein
Residential
Rate
TOTAL
specified agreeing to do all work in strict accordance with the City Codes and
41- umace Shell and Duct Work, Burner -
(ice
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace
$ 30.00
$.
representations stated in this application are true and correct.
(Side Vent - Fill Out Back)
-2 1998
Gas Piping (Needed with new furnace)
$10.00
$ -
OWNER �
Gas Range
$10.00
$
_
51ly 6Z-''
BUILDING USED AS_
Gas Dryer
$10.00
$
ESTIMATED COST PERMIT NO.
Air Conditioning - All Sizes
$ 25.00
$��C.
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
$
No. of Heating nits Circle One (Steam) (Hot Water) (Warm Air)
Trade Name &LA Size No.
Commercial industrial
13TU HP EDR
1.25% of Value of Appliance or Work
$
Fuel Total Connected Load
State Surcharge $ .50
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Burner Trade Name Size No.
BTU HP
HEATING CO
Signed
Approved By _
FILL OUT BACK SIDE FOR
REPLACEMENT FURNACE
EDR
Sharp
Heating and Air Conditioning
Columbia
Rough -In Date
VERIFICATION ON
MIN 55421
Final Date,
0
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CHEIANEY AND STACK VERIFICATION
The
undersigned hereby verifies that the existing chimney or
stack:
1.
Has been carefully examined
Yes ()
No ( )
2.
Is free from rust or deterioration
Yes ()
No ( )
3.
Has no foreign objects lodged within
Yes ()
No ( )
4.
Is securely supported
Yes ()
No ( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes ()
No ( )
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7.
Has a liner been provided for water heater
Yes (
) No ( )
8.
Has combustion air been provided for water heater
Yes (
) No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
SUBJECT
P,PRM1T NO.
City ®f Fridley
� 2 7 6 2
PAT THE TOP OF THE TWINS
BUILDING PERMIT
Ir ,
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
_
PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
-2-7v
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
8/2/94
JOB ADDRESS 4881 Main Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
29,30
1 Plymouth SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Matt Stene 4881 Main Street NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
First Choice Exteriors 2405 Annapolis Ln 553-1918
ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside Dwelling
9 CHANGE QF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SQ. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$5,000
$2.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
'THE
$72.00
Fire SC $5.00
STRUCTION O PERF MANCE OF CONSTRUCTION.
PLAN CHECK FEE
License SC $5.00
TOTAL FEE
$84.50
r� d
SIGNATURE OF CONT RA TOR OR AUTHORIZED AGENT IDATEI
W OPE Y VALIDATED THIS IS YOUR PERMIT
BLDG INS BATE
SIGNATURE OF OWNER 0F OWNER BUILDERI IDATEI
NEW - [ ] . .
19l' Effective 1/1/94
ADDN. _ [ J CIT x •OF MDLEY
ALTER, SINGLE FAMILY AND DUPLEXES R -I AND R=2
Building Permit Application
Construction Address: q 0 y A4 S
Legal Description:
Owner Name & Address: c, -t-7- 5e 'o r, �° -A Tel. #
Contractor: l- l v -sl t�-x-r— MN LICENSE 0
5 -?a •- a l > /
Address: a q b 5 L /U, _55 r uY� MILI Tel. # 3-,>_3
5� JAI—
Attach to this application, a Certificate of Survey of the
lot, with. the- proposed construction drawn on it to scale. - - -
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: —/,-. , y op,- S, of �_y L
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks -
Type of Construction: Estimated Cost: $ 5 ,
Approx. Completion Date: "I" - �-
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + b Ft = Ft x $ _ $
DATE: _ o? 9 APPLICANT: _��TeX. #3-j-3 -I�IS
CITY USE ONLY
Permit Fee
$ � 1r , () 0
Fee Schedule on Reverse Side
Fire Surcharge
$ 5.0 0
.001 of Permit Valuation (1 / 10th %)
State Surcharge
$ 5
$.50/$1,000 Valuation
SAC Charge
$
$800 per SAC Unit
License Surcharge
$ S - DC7
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS:
Sep 28 05 09:34a Scott 763-551-1527 p.1
SEP -27-2005 11:08 CITY OF FRIDLEY P.03/03 , /I Ll
Building
BUILDING
Permits O.:.�
Inspections
RESIDENTIAL
APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd:
DATE q •�. _
O_
YOUR E44AIL ADDRESS •
(�
SITE ADDRESS '
` iRh�
l /& rys
THIS APPLICANT IS:
0 OWNER
CONTRACTOR
PROPERTY OWNER/
NAME
ADDRESS:
STAr! 1jZIf' j
TENANT
PHONE: -1 U6
3 5i -! • 3 \ 1
Y�
CONTRACTOR
CONTRACTOR
NAME: 33Q%
A144g.w
"MIT A COPY OF
STATE LICENSE A 3% ok9 W vA 3- o IA
YOUR STATE LICENSE
ADDRESS: I A4
O Sip a'3 VS t� .... "�D Cr ryypy�y
STATEAZIP / 7
WIAPPLICA'IION
TH
FMIM
FAX ``--
``
PROPERTY TYPE
LIS G E rAMEMNEW
M9S_TR_UCMN SIZE -
G TWO FAMILYMW CONSTRUCTION STORIL' S
PERMIT TYPE
Cl ADDITION
GARAGFJSHED WS
n BASEMENT FWISHROOF 0 DRAIN TILE
D DECK
_ C15IDiNG O OTHER
11SWIMMfiIGML
TYPE OF WORK:
O NEW
ADDITION
MiCEIREPAIR 0 REMODELING
DESCRIBE WORK BEING DUNE -"w%- fA
t.-. SAA `vi. NA--' a o SW6&., 56
%qA Q, kA -
SIZE OF EV[PROVEMIR4T
LENGTH WIDTH
MQHT Sq. it.
RpOFWG
NUMBER OP SQUARES +
O HOUSE any
'*OUSE & GARAOE
RASF•NENT
R_FMODEJ &Q CRB=
GARAGES
O ATTACHED GARAGE �
1.
2.
Exislinloor Plan
pro ted 3 Rom pbm
PROPOSED SIZE:
PROPOSED HEIGHT:
0 DETACHED GABA
pL
3.
List of nmcwal mwnbers to be used
IN
FOR NEW CONSTRUCTION INCLUDING DECKS,
0�
dSo<ilt
ADDITIONS.
F�[i
& RCH MMUM
O Aluminum
O Trim
1.
Site FIawsurvey showing the existing st:uota m
0 Other
Q Fascia
and Proposed prtt{oat.
2.
Two sets of constmaion plants
wpm OtiIrS
IN E=TWG OPENINGS ClYes 13N* LOCATION OF WINDOWS
3.
Emergy Calcalstioes
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE DWALLED
NUt++18ER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INC)6UDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 UJLC FEE SCREDULE)
Permit Pee 1®01 .0 $ See Back Page for Fee Schedule
Plan Review / S 65% of Building Permit Fee
Surcharge $ n (.0005) titres the total job valuation -Minimum $.50
Fire Surcharge S .001 x Perrot Valuation (1110°/a)
License Surcharge S6 ® $5.00 (State Licensed Residential Contractors)
SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft + 6 ft - ft x $20 - $
Erosion Control S $450 Conservation Plan Review
Park Fee S Fee Determined by Engioneeting
Sewer Main Charge S Agreement necessary( ) Non Necessary ( ?
Total Due $ 0j � 09 Make checks payable to: ,City of Fridley _ _ Attach Stipulations
THIS IS AN APPLICATION FOR A K RMrT•NOT VALID UNTIL PROCESSED
1 hereby apply for a building permit and I acknowledge that the imforniation above is complete and accurate; that the, work will be in
eorift manee with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be. in accordance with the approved
plan in the case of all work (which requires review and approval of plans.
SIGNATURE OF APPLICANT Q1,% CL;*T RINT NAME Qb kV 19 N N V- DATE y)
TOTAL P.03
D�
3�3 jv1ep
NOV-16-2004 10:25 CITY OF FR I DLEY P • x:12, 0
ADDN (J 1 $ 6431 University Ave, NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER l J I SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
5.3I'L��
Construction Address: L'c�, A 611 � Sf ree � X F,
Legal Description:
Owner Name & Address: AG[f+�eW Sfie tie, Tel. # 763 -57.x' 21 11
Contractor. _ E l l l h q+a k W I k 0 W S MN LICENSE #
Tel. # 15-2 -'133 —,1,30 0
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length . Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. FL
DECK AREA: Length _ Width _ Hgt/Ground Sq. Ft.
OTHER:
Construction Type: 4a4 t4l Estimated Cost: $ gi 3L14. 0 p
Driveway Curb Cut Width Needed: FL + 6 Ft = Ft x $
DATE: (0' APPLICANT: Tel.# 95-933-6 3,00
Call (763) 572.3604 for Permit Fees if mailing iniication. Fax to 763-571-12$7 if using credit card and we will calf
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ i7.25
$ 109. 9. (a
CITY USE ONLY -
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation .
$1350 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 [ ]s• Not Necessary [ ]