PRE 2010 DOCSCity ®f Fridley, W? 7 797
PERMITBUILDING �
Date: June 9, 1965
owner: d Haugen guilder McCall and Compgq
Address 6377 NanBuren 19. E. Add.ess 1618 W. Lake Street
LOCATION OF BUILDING
No. Street. & #-,- , E Part of Lot
28.,29.,30 IN So. 20 of > io0128 Block 6 Addition or Sub -Division Florence Park
Corner Lot _ Inside Lot Setback
Sewer Elevation
To be Used as:
Type of Construction
Front
Sideyard
Foundation Elevation
DESCRIPTION OF BUILDING
Depth Height Sq. Ft.
Front Depth Height Sq. Ft.
Est. Cost & .1000000 To be Completed
Storm damage repair
Cu. Ft.
Cu. Ft.
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 i,n �com�ce with 21 provisions of
di
ornances of the city of Fridley.
In consideration of the payment of a fee of T— ]12: 00 , permit is hereby granted to Necan & COO
DW D=ad' uH 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= thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regardinglocation, 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.
Allen Jensen Building Inspector
NOTICE
U k permit doe no eoeer the eonatrudion, hatalidtlon for wising, plumbing, gad boding, ewer or water. Be sura to see
the Building Inspector for pparde permtld for thea hems.
v'/'
APPLICATION FOR •NG PERMIT
CITY OF FRIDLEY,,&MMOTA
OAR'S NAME ARVID HAUGEN BUILDER C&A
.e-
6377 Van Buren -14E
ADDRESS _
ADDRESS ADDRESS L
LOCATION OF dLM
No,A Stteet Part of
41 -9111A,y
Lot. 5, A 30 Block Additicat or Subdiviti
Corner Lot Inside Lot e4ifack Side-Yar4 »
SEWER ELEYATXQN FOU MnON MMTZOM,
'M r . --Ii11YW1 ■
Applicant.attach to"this foanun Two Certificates of. Survey of Lot and proposed' -
ing location dr4k.wn on these Certificates.
DESCRIPTION OF BUILDING
ria,be used as:
.ProaC Depth Haight "
Sq. Ft.� Cu. Ft.
____)Front Depth Height
L
Sq. Ft. C l . Ft .
Type of Construction Estimated Cost 14000.n0
-�
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work, ILA strict accordance with the City of Fridley Ordiz=ces and
rulings Of the Depart ni 'of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
- hedule -of Fee Costs can be found on the Reverse Side) .
Roof. Siding. Painting. Glass, screens. General repair.
• 'b�wq .. •r d�
'*� `..v'• BVILDIM PEiMT FEE SCEft%E «.
Section 2. The Inspector of 4u
ildings''siall, b0 vre Eaux any permit for
the erection of any building or stratt;pre, of • for amy add,LtIV to any exist-
ing building or structure, or' for` any ijtera't,�'' is,_�r'..xepaiV* to any existing
buildtxig or structure upon a licatf6a, , require the
P PA erefor, payment by the
applicant for such permit of fees -to ?tMa amount.'heroin-below. set 'forth. -and
in the manner herein provided to -Wit:• `
---
1'_.` For any $uch permit for the er,gpi.on-af` any fireogrq�'f _butld*ug, other +> .
.;.�.- a garage* warehouse, -factory,. oxo':@, itt' 04-evot.W4 qF £or the erea.ton 'Of
any `fire -prof addition,. for. Is3a$l8i"°a Panay# �a a#y a e6iog bulld3 '' ;:' >•
Shall be at the rate of $x,.40 for doh;, :thousand jiubie feet, or fry
thereof in such cubical cont pts,
2.2,; - For any' such permit. fot'.., a .erection . of any firerproof . goraim-
ori er grain elevator, or fpv.:the a_ ection of any. •', % f
for similar occupancy:,
. g ildi�g sha�3,' •be at a ' e
.�.r fo{'daoccupanc, to.y e:kis•t1i
eh one thousand cubic leet,$',. classified .#s, " fireproaf" by-
the--�in�agoL•.ia'-•8asfid"il�• L'O�,+ria�.ws,^t; .. • .
HOUSES
F6r any such permit for:the erection of any non-firep"f b'uildi'ng
4.
than a garage, 'warouse, factory or, grain elevator, ' or shy, note -film
additiO4 for Simi''Adr oceupAhloy, to any esistij% 14il4dU4 pe=it $1:4DO for --
each ,one thou1jaaad •ctibi.tw• feet,
GARAdES
2. 4_ For any such permit for the erection of any non -fireproof garage,,,
warehouse, factory or grain elevator, or for the erection of any non -fes _...
a ►Y,--f-0r--itAilar' occupancy, to any existing building. Or for each such
or addition - ninety'cents.($0.90) for each one thousand cubic feet
=rfta:!jOa thereof , in the cubical• contents thereof with a minimum:of 40
For the purpose Of- computing fees for building permits, the cubical ceretentir
Of any building or addition to. a uniform.. height throughout 'by MuLtiplying,tha,''
.ground area covered.from a point six (6) inchoO below the floor line of fihe_'
basement or cellar to the average height.of the u
average height of the roof surface ofthe main AA®r surface or to the'
gable of a, pttbhed roof.
22.5•. For repairs or alterations to an existidg 9truct k•. 'the fee shell'
..,,at the rate of $3.00 per each Five hundred. Doha;s
.. therebf in the cost, 'bf ellr proposed work;
2_#6 in no case
shah the 'forth in''
,Section" ,be •iese
Oct. 23, 1968
Home Owner: Arvid Haugen
6377 Van Buren St. N. E.
560-2008
Contractor: United Construction Co.
2727 Lyndale Ave. South
Attn. V. Rockier
No License- Section 18.01 And 18.02 City Code
No Permit- Section 45.464 and Section 301 (A) Uniforn Building Code
The following conditions are not code violations:
1.Front steps cracked at the bottom of the stair riser -
Apparently poured over the old steps.
2. Rain gutters improperly sloped to down spout at sentry.
3. Precast stone veneer shows cracking in all areas. Water not
entering building yet. This work was done in March 1968 so
adverse weather condition may have caused excessive shrinkage.
CLARENCE BELISLE
Building Inspector
,Y6 f s c C -e S 0 C-- > Mrd r �- / �' ;2-
p Al
d� ��� c t� s N .o
5 o 1,/•-e 6 x l ec) c 0
�e . 2 xG •o SS's G
a
HOUSE- HEATING TEST RECORD 0,fs�
ADDRESS (c,��� I�^R �� APT. FLOOR CITY SU
OCCUPANT Z— OWNER
HEAT LOSS 10w, AO'e- DATE HTG. INST_
SOLD BY a 4:�A_ow-lf: INSTALLED BY ARS', 'ft ire G`�,rrtr
Electrical Work By //iSDw ��� Cr Gas Line By 'Aft -
TYPE OF HEAT GA &000"1_WFA HW STEAM SPACE HTR. UNIT HTR. THER•
GAS DESIGN
MAKE ,� �� efk P &6' —MAKE
Model C' 1*n d E s .J Model
Serial-� '1 ^ V`�' / ice� Max. I
INPUT —4400
MAKE
CONTROLS
THERMOSTAT hSeW Heat P I ug
Valve w44- -
Limit A,.G*
Limit Setting
Fan Setting
Pilot Type T„�►,.i- �rt �%w-s�ss�►
Pilot Make k/
Pilot Model mow"'.
Pilot Timing %
L.W. Cut Off
Model
CONVERSION
OF BURNER _1fG�
41"
ITU Rating
OF FURNACE
Vent Size J
KIND OF LINER%�� SIZE &"' NONE
Draft Hood 17 jff&W_0r RegulaTor
Fi Iters Size A' u tuber L
Chimney Location Inside ✓ Outside
Chimney Construction
Smoke Bomb `' Wiringy
Draft
A-,
Test Tag
Door Pressure Z__ Lighting Inst. 44:!f
3 s"
Pressure� -Percent CO Date Tested
Input CFH Percent 0 Company Testing / 'r
� r
Stuck Temp. ��� Percent CO `p Name of Tester �% ,at
Form 235 W
CITY OF FRIDLEY INSPECTION DIV, Effective On January 1, 1993
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
672-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential Rate TOTAL
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace $ 20.00 $ ®?®,
Gas Piping (Needed with new furnace) $10.00 . $
Gas Range $10.00 $
Gas Dryer $10.00 $
*Alr Conditioning — Ah Sizes $10,00 $
All Others/Repalrs_& Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $
Comfi wo'lal/Industrial
1% of Value of Appliance or Work $
State Surcharge $ .50
TOTAL FEE 10?0 •,:;,a -
REINSPECTION
a
REINSPECTION FEE $30.00
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
JOB
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes and
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
W- /W ^ ,1993
OWNER_��,�,�j�
BUILDING USED AS
ESTIMATED COST PERMIT NO.
DESCRIPTION 12,EUR A�1 CE ANQ OR BtMtJER
No. of Heating Units�l CIrL- ne_. (Steam) (Hot Water arm Air)
Trade Named ® j� Size No.���r ®6 ®'*1c ,c'
BTU HP EDR_
Fuel Tobe{; C.onriected Load J 7 '-f
Burner Trade Name " -: _+ Size No.
BTU HP°= _ EDR
HOME ENERGY CENTER
HEATING COMPANY 14505 : 21ST AVE. NO. #222
Signed Tel No.__I�16 Z/e O
Approved By (: 1 f Rough—In Date Final Datef® 1p
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
R
k
C MIMY AND BTACK 9SRIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined
Yes &A
No.
2. Is free from rust or -deterioration
Yes �j
No
( j.
3. .Has no foreign objects lodged within
Yes
No
4. Is securely supported
Yes
No
S. Meets all current Code requirements for
size and total BTU's connected
Yes {
No
( j
6. Has total heating BTU's of
All other BTU's �n
TOTAL BTU's �� , oz>J
Remarks
List Alterations Being Done:
NOME�NERGY CGN ER
14505 - 21 ST AVE. NO. #222
PLYMOUTH, MN 55447
HEATING COMPANY
Signed By
Date
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572--3604
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential
Fumace Shell and Duct Work, Sumer —
Also Replacement Fumace
(Side Vent — Fill Out Back)
Gas Piping (Needed with new fumace)
Gas Range
Gas Dryer
*Air Conditioning — All Sizes
Rate
$ 20.00
$10.00
$ 10.00
$10.00
$10.00
All Others/Repaim & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial C) P HD'As G
1% of Value of Appliance or Work
State Surcharge
TOTAL FEE
Effective On January 1,199'
JOB ADDRESS % 3 i U u rz T i J
C-
k The undersigned hereby makes application for a permit for the work herein
TOTAL specified agreeing to do all work In. strict accordance wfth the City Codes and
rulings of the Building Division, and hereby declares that all the facts and
$ representations stated In this application are true
correct.
$
OWNER
$ BUILDING USED AS
ESTIMATED COST PERMIT NO._ . _ 9/3
DESCRIP33ON OF FURNACE AND OR BURNER
$ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
$ Fuel Total Connected Load
gso
�SD
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $1500
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
*Air Condi#oners can not be placed in a side yard without
written permission from adjoining property owner.
Burner Trade Name Size No.
BTU HP EDR
HEATING COMPANY t T6 ,
Signed By Tel No. I ®1
Approved Rough—in Date fiat Date
t
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
NOTE: #1 through #'8 required when using a side vent furnace.
The 1.1 g1 1 hereby e! 1 :+.that!1-' existingchimneyor stack -
1.
Has been carefully examined
Yes {)
No
( )
2.
Is free from rust or deterioration
Yes ()
No
( )
3.
Has no foreign objects lodged within
Yes {)
No
( }
4.
Is securely supported
Yes {
}
No
( )
S.
Meets all current Code requirements for size
and total BTU's connected
Yes ()
No
( }
6
Has' total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for wager heater Yes ( ) No ( )
8. Has combustion air been provided .for water heater Yes ( ) No { )
HEATING CO.
Signed By:
Date:
Wk
su6JEeT
ERMIT NO.
City ®f Fridley
28396
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
')672®�NITY DEVELOPMENT DIV.
O
j PROTECTIVE INSPECTION SEC.
0 �
`�
0
t
CITY HALL FRIDLEY 55432
NUMBER=11EVDATE
PAGE OF
APPROVED 9V
612-571-3450
910-F110/23/98
i
JOB ADDRESS
6377 Van Buren Street NE
1 LEGAL
I LOT NO.
Pt . 2$
BLOCK
I TRACTOR ADDITION
SEE ATTACHED
DESCR.
29, 30
6
Florence Park Addn. to Fridley SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Harry Sandoz571-2008
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Owner
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 a REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (20 S 2nd Layer
9 CHANGE OF USE FROM TO
STIPULATIONS
Roofing can be the 2nd layer but not the 3rd.
SEPARATE PERMITS ARE REOUIREO 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 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1287
$.64
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$43.00
Fire W $1.28
PLAN CHECK FEE
TOTAL
4 2
SIGNATURE OF CON'aACTOF+OA AUTHORIZED AGENT iDATEi
EN�RMAIDAT
HIS ISY UR PERMIT
�z2QPiDATE�
666......����/�///
G -
T�A�E
Wk
r
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description: _
Effective 1/1/98
X Owner Name & Address: r� '�, Tel. # 5 71 —;210 QK
\/ Contractor: `,5 e- F MN LICENSE #
/� Address: 63 % 2 "n Tel. #
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:
/Construction Type:
DESCRIPTION OF EMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground _
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Sq. Ft.
Sq. Ft.
Sq. Ft.
Estimated Cost: $ 4 y2 6 7
(Fee Schedule on Back)
Ft x $ _ $
DATE: APPLICANT: Tel.
CITY USE, ONLY
Permit Fee $ 113,00 Fee Schedule on Reverse Side
Fire Surcharge $ A W8 .001 of Permit Valuation (1/10th%)
State Surcharge $ (p $.50/$1,000 Valuation
SAC Charge $ $1000 per SAC Unit
License Surcharge $ $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:
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 VALUE FEES
$1 to $500 $21 (Minimum Fee is $21 plus surcharge)
$501 to $2,000 $21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$2,001 to $25,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$100,001 to $500,000 $887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $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)
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 it has been constructed
will be required before proceeding with the framing.
F
SUBJECT
City ®f Fridley
29389
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIPT NO.
� • _ COMMUNITY DEVELOPMENT DIV.
SEC.
r � � PROTECTIVE INSPECTION
CITY HALL FRIDLEY 55432
�""�
NUMBER
REv
DATE
PAGE Of
APPROVED By
612-571-3450
910415
5/4/99
JOB ADDRESS 6377 Van Buren Street NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
28-30
6
Florence Park Addn to Fridley
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Harry Sandoz 6377 Van Buren St NE
571-2008
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Affordable Window Systems 9309 Lyndale Ave S, Bloomington, MN 55420 888-9073
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO
20106910
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION O ALTERATION Ej REPAIR
0 MOVE O REMOVE
8 DESCRIBE WORK
Repair Siding - West side only
9 CHANGE OF USE FROM TO
STIPULATIONS
Call for building wrap inspection before covering.
SEPARATE PERMITS ARE REOUIREO 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
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$500
$ .50
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-
$21.00
Fie SC $.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
T L FEE
Licen SC $5. 0
$27.00
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT iDATE,
HE P Y AL1
D THIS IS YOUR PERMIT
S,GNATURE OF Ow NEROF OWNER BUILDER, ,DATE,
DG ,NS
DATE
F
NEW
ADDN
ALTER
ConstructionAddress:
-34P -0 q
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Legal Description:
Effective 1/1/99
31
Owner Name & Address: 14 A0 4'1. A � p— �zr�� �'t r�� Tel. # �'7� -4006
Contractor: _ A 0 64% , Co' V ou'9 6 *AJ MN LICENSE # 0 B ®-- &oq1
Address: q3 AriTel. # 3ee IM 13
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
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: j1W192APPLICANT: Tel. #
Permit Fee
.$ 1 Ob
Fire Surcharge
$ 15
State Surcharge
$
SAC Charge
$
License Surcharge
$
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $ �` ®®
STIPULATIONS: 2� q1
25�!� 2
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1 / 10th %)
$.50/$1,000 Valuation
$1050 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 [ ]
BUILDING PEMM 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 FEES
$1 to $500 $21 (Minimum Fee is $21 plus surcharge)
$501 to $2,000 $21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$2,001 to $25,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$100,001 to $500,000 $887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $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)
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 it has been constructed
will be required before proceeding with the framing.