PRE 2010 DOCSZ
BUIlLDING PERMIT
j
0
N 2323
`
I
Ir
Village of Fradie , Minn.
g Fridley,
Datea ai
..................................
Owner e?
.� .. s r �'� . , ... Builders ................................. .
Address
..... ........'Address ..... ........... ......... .
. ...... ...
LOCATION OF BUILDING
No. . .:'
Street /44; aPart of Lot. . i . .... .
Lot . . I
. Block .. Addition ,or Sub -Division �
Corner Lot ........
Inside Lot.. Setback . " Sideyard Al-�Vod ............
�1
DESCRIPTION OF BUILDING
To Used as:
Abe
.`'.�.::�.. 1
Front8'.... Depth AA. Height Sq. Ft. Cu. Fi. ........
...................1(.
Front ......... Depth ........ Height ......... Sq.,; Ft.......... Cu. Ft........ .
Type of Constructl+��V-
f
Est. Cost ..... y ..... To be Completed N°... u4: ! ..
l
In considerationjl�of
i.
the issuance to me of a permit to construct the building described above, I agree to do
the proposed work
ordinances of ;0v
accordance with the description above "set forth and in compliance with all provisions of
age of Fridley.
, • . .
consider
f the payment of a fee of $ f "rte;". f-, permit is hereby granted t . .i ........
... ...
to construct the building or addition as described above. This permit is granted upon
the express conditio�j
that the person to whom It is granted and his agents, employees and workmen, in all work
done in, around and
Fridley, Minnesota
ppon, said building, or any part thereof, shall conform in all respects to the ordinances of
locaiion, construction,
r
.garding alteration, maintenance, repair and moving of buildings with-
in thelvillage limits
ordinances.{I
and this permit may be revoked at any time upon violation of, any of the provisions of said
,. „a�.� 1�:i� Building Inspector
NOTICE:
I
This permit d4fes
not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water.
B1f sure to. see the Building Inspector for separate permits for these items.
i�
Z
Application for Power Plants and Heating. Cooling. Ventilation, Reftigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work .......................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECK. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ..... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ..... ................. 5.00 $
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ......................— x $1.50
Additional Fixtures x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $ p
AIR CONDITIONING $ 0
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $
ALTERATIONS & REPAIRS TOTAL FEE $
ROUGH At 0- ' ��/ 6.
/� 4Z
FINAL � o�
Dept. of Bldgs. Phone 560-3450
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 �e true and correct.
Fridley,
Owner & n
Kind of Building
Used as
To be completed about I
/
F9 -V
Estimated Cost,
ONew. Building Permit No. Permit No.—
DESCRIPTION
o.
DESCRIPTION OF WORK
HEATING or POWER PLANTS–Steam, Hot Water, Warm Air—No
19
Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
Total Connected Load Kind of Fuer
BURNER —Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVER)
Application for Power Plants and Heating. Cooling, Ventilation. Refrigeration an
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work .......................... 8.00 $�
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $
Furnace Shell & Line—to 640'sq. ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $
OIL BURNER—to 3 gal. per hour 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) 5.00 $ i
GAS FITTING FEES:
NO RATE TOTAL
1st 3 Fixtures ......................
x $1.50
$ �� S 6
Additional Fixtures . ...............
x .50
$
Gas Range to 200,000 BTU ...........
x 2.00
$
AIR CONDITIONING
$
FAN HEATING SYSTEM
See Fes Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
TOTAL FEE
ROUGH
FINAL
Dept. of Bldgs. Phone 560-3480
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.
-4 A Fridley, Minn--�,�-` '�Oz
Owner
Kind of
Used as
To be completed about
"-`�®
Estimated Cost, $�
Old New. Building Permit No. Permit N0.\1_
DESCRIPTION OF WORK
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 Loa Kind of FueL.
s�
BURNER — Trade Namt, Size No. -Say,��7
Capacity ' Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVER)
SigneQd/L✓7' - s
B
-QBP. 42 Business Phone
City of Fridley
SUBJECT
r
rENO.
4 285
AT THE TOP OF THE TWINS
P E R fill
BUILDING
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 . �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
JOB ADDRESS 6220 Trinity Drive N. E.
1 LEGAL
LOT NO.
BLOCK
TRAC T OR ADDITION
SEE ATTACHED
DESCR.
4
3
Sylvan Hills Plat 3
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Floyd B. Watts 6220 Trinity Drive N.E.
571-0226
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.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 10' x 1615" Storage Shed
9 CHANGE OF USE FROM TO
STfPULATIONS
SEPERATE PERMITS REQL"Kd FOR WIRING,
HEATING, PLU?*8ING AND. SIGNS.
WARNING
Before digging -IGAS
TELEPHONE L CITRIC Eta
REOUiRED BY LAVA
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
Wood
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
1
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,
$1, 221
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
.60
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-
$7.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$8.10
SIGNATURE OFCONTRACTOR ORAUTHORIZED AGENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR. PERMIT
BLDG INSP
02SIGNATURE
DATE
OF OWNER IIF O NER BUILDERI DATE
• CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER: ®. �" - �� T-5, BUILDER:
e��
Address: ?D� Vii. /-i� —• Address:
Tel. No.:—
No.
o.
No. Street:
• LOT: BLOCK:' AD • ITIO ✓�,.�v / T "Ox
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS:
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:
I�f.. Front: Height:
Square Feet' Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
of Construction: ��Z �.
Type �� � e� � -- Estimated Cost: $ -�
Th Be Completed: ®// / Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired
(SEE REVERSE SIDE OF SHEET)
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. See reverse sid a itional in at' n.
'-aDATE: %SIGNATURE:
Stipulations:
AW
BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings 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 repairs 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:
NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet.
PLAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSION: (Concrete Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x $11.75
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3 foot wide approach with
6 inch depth; Driveway width plus 6 feet x $15.40
1 / _= 91 d
For the purpose of computing fees for building permits, the cubical contents of any
building or addition, is determined by multiplying the ground area covered from a
point six (6) inches below the floor line of the basement or the cellar to the
average heights of the upper surface'or to the average height of the roof surface
of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the rate
of $3.00 Fier each five hundred dollars ($500.00) or fraction thereof in the cost
of all proposed work.
In -no case shall the fee charged for any permit as set forth in Section 2 be less
than $7.50 plus $.50 state surcharge.
VERIFICATION OF FOUNDATION
NOTEc 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 been constructed will be required before proceeding with the framing.
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 not be used or occupied until a Certificate of Occupancy has
been issued.
SUBJECT
PE NO.
City of Fridley
-
AT THE TOP OF THE TWINS
B U I L D I N G PERMIT
_ .1769
r
.
EIPT
• _____ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
r � � PROTECTIVE
1 � �
�ITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L , \ 612-571-3450
910-F15
8/29/84
JOB ADDRESS 6220. Trinity Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
4
3
X Sylvan Hills Plat 3 SHEET
I
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Floyd Watts 6220 Trinity Drive N.E. 571-0226
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
D & M Construction 2611 Newton Avenue N. 521-1871
4 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
X
8 DESCRIBE WORK
Reside Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
y
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Al=inwn
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
000
$1.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$3, m
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
Y OTHER STATE OR LOCAL LAW REGULATING CON-
PEMANC OF CONSTRUCTION.
$38.50
LAN CHECK FEE
TOTAL FEE
W-7
$40.00
SIGNA RE OF CO AAC OR URAU NO ED AGENT (DATE)
WHEN PROPER IDATED THIS IS YOUR PERMIT
y . B40G INSP 2AA-`4
SIGNATURE OF OWNER OF OWNER BUILDER! (DATE)
NEW [ ]
City of Fridley Effective 4/1/84
ADDN. [ ] �R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address: 6 -;_1 2 d
Legal Description: [-U/
Owner Name & Address:F�vYOI✓�TTSa ;r�i�/7-17 Tel. #
Contractor: f% "7 dAlS%�vCT/ovz/ Tel. #
Address:lile2oll7-642
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
GARAGE AREA: Length
DECK AREA:
OTHER:
Width
Height
Sq.
Ft.
Width
Height
Sq.
Ft.
Width
Hgt/Ground
Sq.
Ft.
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback ,Side Yard Setback
Type of Construction: 62tLe4ol-diw� Estimated Cost: 5 0 D
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
DATE: 7 APPLICANT: Tel.
CITY USE ONLY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS•
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$425 per SAC Unit '
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
BUILDING 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 Valuation Fees
$1.00 to $500.00 $10.00 (Minimum Fee is $15.00)
$501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and including
$2,000.
$2,001.00 to $25,000.00 $32.50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraction thereof, to and
Including $25,000.
$25,001.00 to
$50000.00
$170.50 for the first $25,000 plus $4.50 for
each
additional $1,000 or fraction thereof, to
and
including $50,000--
50,000.$50,001.00
$50,001-00to
$100,000.00
$283.00 for the first $50,000 plus $3.00 for
each
additional $1,000 or fraction thereof, to
and
including $100,000.
$100,001.00 and up
$433.00 for the first $100,000 plus $2.50 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
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 been constructed will be required before proceeding with the framing.
r�
SUBJECTER
O. -
City of Fridley
9 6 7 0
AT THE TOP OF THE TWINS
BUILDING
PERMIT
i •
1 L
O'
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
r
CITY HALL FRIDLEY 55432
�-__.�
NUMBER
REV
DATE
PAGE OF
APPROvEO BY
`�
612-571-3450
910-F15
6/11/99
JOB ADDRESS 6220 Trinity Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
L�
3
S 1 van Hills
Plat 3
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Connie Watts
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
Richard Hastings 6331 Riverview e
-
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP
PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS
ZIP
PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION O ALTERATION ®X REPAIR
❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage (19_Sq) Te r -off
9 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. 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
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
$1661
$e83
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 COW
$6O
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
m.1O
Fire SC $1.66
r
PLAN CHECK FEE
TOTA FEE
Li cens C $5.
7.59
SIGNATURE OF CONTRACTOR OR AUT Ri2ED AGENT 015ATe.
EN O V I
8L2,NSP
A THIS IS R P T
r
MATE
S,GNATURE OF OWNER,IF OWNER BUILDERI iOATE,
NEW[ ] _ Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 -I O
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name &Address: C, -v ' L-% rr d lS Tel. #
Contractor: ALS7 ®At6 S MN LICENSE
Address: jLzz�o L 'U t�: Z Tel. # S 7 V - V.1a
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
GARAGE AREA: Length
DECK AREA: Length
OTHER: f V
DESCRIPTION OF EMPROVEMENT
Width Height
Width Height
Width Hgt/Ground
r^ —r-_
_ 0
Construction Type: -r� A ?,- 4- Kj�7 1L Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Ft x $
Sq. Ft.
Sq. Ft.
Sq. Ft.
DATE: APPLICANT: Tel. #
TOTAL
STIPULATIONS:
$ �7rS9
CITY USE ONLY
Permit Fee
$ (' , !
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ 83
$.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC Unit
License Surcharge
$ , d
$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:
$ �7rS9
BUILDING PE10M 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
$23.50
$23.50 for first $500 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 $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$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, 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 $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.