PRE 2010 DOCSSUBJECT
I
PE T NO.
City ®f Fridley
14534
AT THE TOP OF THE TWINS
U I L ®I N G P E R M I T
i
R CEIP
�
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
9 4
r � �
1 . �
"1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
1230/77
JOB ADDRESS 5601 West Bavarian Pass N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
22
1 Innsbruck Villages SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Darrel A. Farr Development 7286 - 72nd Lane North 560-8110
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSENO.
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
X
8 DESCRIBE WORK
Construct a 24' x 35.5' Townhouse and a 20' x 23' Garage (Sunnenheim)
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide combustion air to furnace area.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.i�
Wood Frame
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
R-1
984+460
22,936 Total
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$30,375
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
W EN PFJOPERAVALIDATED THIS IS_YOUR P MIT
BLDG )NSP - "OE
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
APPLICATION FOR RESIDENTIAL, A1,'1'1:RA'1'IU',
OR ADDITION BUI1,UING PEP.IMIT
CITY OF FRIDLEY, x.111\\ESOTA
OW ER' S NAtiE : �►t ar�� F��� � �, BUILDER: �S'a - _
ADDRESS : 7j8dP M '"l -40e- Al ADDRESS: _dy,41 . des--�.z a
2;0:STREET: 4a, 9?eA9A-/407 /�9 S -r
LOT: 2 BLOCK: ADDITION:��xo6N,ycAl®k s
CORN -ER LOT: INSIDE LOT: &0"0' SETBACK:: SI DEYARD :
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Ze Used As:
75;vn 7ousc . Front: Z4 Depth: Z S'. ,S' Height: X0
Square Feet: ®749-' Cubic Feet: ®8200
24. Front: 2.0 Depth : Height: ®�
Square Feet; 4340 Cubic Feet: -4-300
Type of Construction: Aldoad A004r., Estimated Cost: �0000
T
To Be Completed: ®�
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict-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 :ZAPW
SIGNATURE
(See Reverse Side For Additional Information.)
acv
APPLICATION FOR
POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
Furnace Shell. & Duct Work to 100,000 BTU
.AIR
CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
4.00
S
1
GRAVITY 7tiARB1 AIR:
RATE
TOTAL
Job Address
Furnace Shell & Duct Work
$12.00
$
$
Replacement of Furnace
Repairs & Alterations -up to $500.00
7.00
$ Department
of Buildings
Repairs & Alterations each add. $500.00
4.00
$
City of y
ridle
Fridley
Tel. IF -3450
MECHANICAL WARLI AIR:
Sq. Ft. EBR
BTU
Furnace Shell. & Duct Work to 100,000 BTU
$12.00
$Z,--?,L,�'
each add. 50,000 BTU
4.00
S
Replacement of Furnace
7.00
$
Repairs & Alterations -up to $500.00
7.00
$
Repairs & Alterations each add. $500.00
4.00
$
STEkki OR HOT WATER SYSTDI:
Boiler & Lines up to 100,000 BTU
$12.00
$
each addn. 50,000 BTU
4.00
$
Boiler only up to 100,000 BTU
7.00
$
each addn. 50,000 BTU
6.00
S
OZL BURNER- to 3 gal. per hour
$10.00
$
each add. 3 gal. per hour
10.00
S
GAS BURNER- from 100,000 BTU to 1990999 BTU
$10.00
$ /c
(over 199,999 BTU see Fee Schedule)
S
GAS FITTING FEES:
1st 3 Fixtures is
$ 3.00
Additional Fixtures X
$ 1.00
S
Gas Range to 199,000 BTU x
$10.00•
$
AIR CONDITIONING�1+rx v �` "�
$
A.N t
FHEATING SYSTEMS See Fee Schedule
$
VENTILATING SYSTEMS
$
.ALTERATIONS $ REPAIRS S
$
State Surcharge
$ .50
TOTAL FEE
$ -S •`� ZJ
TOUGH INS?. REINSPECTION FEE
Date ($10.00)
rniAL INSP. - �2 4c -
Date
APPROVAL
FOR PEX41T
VIN2MUX FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.SO STATE SURCHARGE
The undersigned hereby makes application for a permit for the work hetero
specified agreeing to do all work in strict accordance with the City Codes •.
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
Fridley, Minn. 19 �
OWNER FGtit'Z
KIND OF BUILDING
USED AS �� L I h vA
TO BE COMPLETED ABOUT
ESTIMATED COST<
OLD -BUILDING PERMIT NO. PERMIT NO.
DESCRIPTION OF FURNACE/BURNER
HEATING'or POWER PLANTS, Steam, Hot Water, Warm A No. J
Trade Name n v��t: r \ CA. -Size No. . G. i i rs'0
Capacity
Sq. Ft. EBR
BTU
HP
Total Connected Inad
�� �.
Kind of Fuel
? -�
BURNER - Trade Name
Size No.
Capacity Sq. Ft. EDR BTU HP
GEO. KDG111!,IK
Company
Signed By
Tel. No. - . - .., . •� �y� .
r
s9 p • a
zk.crx
HEAT LOSS CALCULATIONS; � � �'3 AOR 09 T 00d99� .��.: MINNEAPOLIS, Mt�1.,_
Weatherstrips
A.S.W,V:E.
Guide
Reference
l g
Construction No...
insulation
�. Windows
Doors
out. Wall
Int. Wall
Ceiling
Roof
-9`--
Floor
Kind
— -
How Applied �.
-
Ya No
Yes -No
_
fi, Room Length`X Width 41 fieigh4Q
FIsXFa�
.
Raom Length Width Height
Windows and Doors-Crackage and Area
�br
and Doors-Crackage
and Area_
No,
Widrh ' Height
of iollh, of pane
No. of
fights
Lineal ft.
of crack
Area
sq. ft.
_Windows
yt iatn Height .1%4o. of
No' et p.?nc tights
Lineal ft.
of cvr�ack
Area
sq. ft.
ay�ne
1
i
Coefj
Btu
!
Coef Btu
Infiltration'.
Glass
4
Exp. wall f & far
��
Y7
C'
Infiltration
Glass
Exp. waII
IT
>
Net exp. wallL
Net exp. wall
Int. wall
Ceiling
Int. wall
Ceiling v9
Floor ^'�
��
.La
Ifoo
Floor
-
Total Btu.Total
Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
cvRequired
sq. ft. E.D.R. or sq. ins. W.A. Leader area
Room Length ftf. Width Height
� FI G Room i Length Width /5 Height
Windows and Doors-Crackage
and Area
Windows and
Doors-Crackage and Area
d`
No Width Height
of pane of pane
No. of
lights
Lineal ft.
of crack
Area
sq• ft•
tA,drh
NO' of pane
Height No. of Lineal ft.
of pane sights of crac@k
Area
sq, ft.
Coefl
B to
Coe f
Btu
I: infiltration
Infiltration
Glass
Glass
- -
Exp. wall
Ex wally
— Exp.
- --- � � =• - ---- ---- -
Nit ex �va!I fi
R•
- N e , exp.
Int. wall
Ceiling
ng
- -- -
Floor
total Btu.
Required sq ft F.D.R. or ;,q, iris. W.A. Leader area
_ � --
q�
Net exp. wall
----1
Il
-� —
r'
- — -
o- k '
-----
Int. wall
!
C Ceiling _
- - -
--- -- �-
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area-'--
T
---
r'
-
Fl.t: Room Length; Width
Windows and Doors-Crackage and Area
Na Widtn 1 He,aht ( NO, of a ,eal >t`.'TI"a•e•a�
'�� Height
-^
.3-"•;
Fl.d,� r,4omenptt," Width
!Nindows and Doors-Clackagf, and Area
:`t�,.--- n. e ft.Y-.Area
No-_°_ t _A_ f ot �i�tti+
�
Heights ry
..`
BtJ
Coefi
Btu
-Infiltration
141
r
iP
Infiltration
Glass
Exp. wall - --- - ---- - ---' �_i_._
Net exp. w'ali - --- -, I
--
-
Exp. wait
Net exp; tufa!!
13,u
<
01-
-
�
_1
Int. wall
—�
Int. wall
r
Ceiling - -
Ce i I vii
'Floor`
—"
Totall3taz;
�
Total Stu:_::
y
,Requirad sq ft. E:D.R or sq. ins_ W.-,. Leader area
-
� �, � ..:!
ReSu,red sq, a. E D .F sir sq ins. W.A. er area'
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PARTIAL RATE
SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures
x
$3.00
Future Fixture Opening
K•
d
$
Water
d
.°�
$
Catch Basin
x
$5.00
N
+�+ toQ
_� x
$5.00
W
(d w
pa,
w
5
Water Softener
Heater
.f
m
New Ground Run Old Building
x
$5.00
m
Electric Water Heater
x41
t
w
.04
0 0
a
o
1st 3 fixtures
W
'$3.00
Additional Fixtures
x
$1.00
$
Gas Range to 199,000 BTU
x
$10.00
$
.4 0
ro
b
m
q
i1
to
.°�
U
w
D
ro
m
c�
0
3
Q w
o
4
N
tod"
U w
ac 3
v
+�
0
as
lec
I
I
1
1st
2nd
3rd
4th
(R) = Future Connection Opening
Connected with Sewer
M = New Fixture, Old Opening
Water
PARTIAL RATE
SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures
x
$3.00
Future Fixture Opening
x
$2.00
$
New Fixture, Old Opening
x
$2.00
$
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTU
_� x
$5.00
$
100,000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7.00
$
New Ground Run Old Building
x
$5.00
$
Electric Water Heater
x
$5.00
$
GAS FITTING FEES:
1st 3 fixtures
�� x
'$3.00
Additional Fixtures
x
$1.00
$
Gas Range to 199,000 BTU
x
$10.00
$
REPAIRS $ ALTERATIONS
Job Address 5 6 o< B wj G� C
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn./✓� , 19
OWNER D OLNC-t e
KIND OF BUILDING
USED AS @
TO BE COMPLETED ABOUT
ESTIMATED COST
OLD - 14EW BUILDING PERMIT NO. PERMIT NO.
Company e -t4_
..,
Signed By _ ���
Tel. No.
ROUGH INSP.
Date
FINAL INSP. Y '
Date
APPROVAL FOR PERMIT /
First $100.00 $5.00 $
each add. $100.00 or fraction $2.00 $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.SO pLUS $.SO STATE SURCHARGE
State Surcharge $ .50
TOTAL FEE $
REINSPECTION FEE
($10.00)
97-8)--416051 CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures
x
�.
o
Future Fixture Opening
x
$2.00
v
.
x
a
$
Water
A
Catch Basin
x
$5.00
$
Water Heater - to 99,000 STU
014
$5.00
$
100,000 BTU to 199,000 BTU
x
w
$
Water Softener
Heater
$7.00
_
$
New Ground Run Old Building
x
$5.00
$
Electric Water Heater
x
$5.00
w
GAS FITTING FEES:
1st 3 fixtures
x
'$3.00
$
Additional Fixtures
x
$1.00
$
Gas Range to 199,000 WX
x
$70.00
$
REPAIRS $ ALTERATIONS
0
First $100.00
$5.00
$
each add. $100.00 or fraction
v
a
rd
State Surcharge
3
64
I
g
U
O
lec
M
0
0 w°
rba
as
1st
ran
Te
2nd
3rd
4 th
(R) = Future Connection Opening
Connected with Sewer
(•) - New Fixture, Old opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures
x
$3.00
$
Future Fixture Opening
x
$2.00
$
flew Fixture, Old Opening
x
$2.00
$
e
Catch Basin
x
$5.00
$
Water Heater - to 99,000 STU
x
$5.00
$
100,000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7.00
_
$
New Ground Run Old Building
x
$5.00
$
Electric Water Heater
x
$5.00
$
GAS FITTING FEES:
1st 3 fixtures
x
'$3.00
$
Additional Fixtures
x
$1.00
$
Gas Range to 199,000 WX
x
$70.00
$
REPAIRS $ ALTERATIONS
First $100.00
$5.00
$
each add. $100.00 or fraction
$2.00
$
State Surcharge
$ .50
TOTAL FEE
$ 1d,5O
REINSPECTION FEE
(510.00)
Job Address 560. West Bavarian Pass
Department of Buildings
City of Fridley
Tel. $571-3450
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. 0-10-78 , 19
OWNER FARR '
KIND OF BUILDING frame
USED AS res,
TO BE COMPLETED ABOUT 8-17-78 - - --
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
Company
Signed By MINNEGASCO
Tel. No.
ROUGH INSP.
Date
o '
FINAL INSP."'/"
Date
APPROVAL FOR PERMIT !&�(
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLUS $.SO STATE SMCM%.RGE
SUBJECT
PERMIT NO.
City of Fridley
—_
rr._—
i 4 1 4
AT THE TOP OF THE TWINS
BUILDING PERMIT
V
r
RECEIPT NO.�
� • _ COMMUNITY DEVELOPMENT DIV.
a.------�
r i PROTECTIVE INSPECTION SEC.
o-�
1 CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
5/7/96
JOB ADDRESS
See Below
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
V ariou
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Various
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Columbus Exteriors Inc 2111 Ill Tm, rnon Rapids MN 55433 868-9192
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Townhouses
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
ieside 44 Units (11 Buildings)
9 CHANGEOFUSEFROM TO
STIPULATIONS 1.
5600,5602,5604,5606 West Bav ian Pass; 5601,5603,5605,5607 West
Bavarian Pass; 5610,5612,5614,5616 est-Baveflae-Pass; 5620,5622,5624,5626 West
Bavarian Pass; 5620,5622,5624,5626 North Innsbruck Ct; 1521,1523,1525,1527
Trapp Court; 5650,5652,5654,5656 West Bavarian Pass; 5660,5662,5664,5666 West
Bavarian Pass; 5661,5653,5655,5657 West Bavarian Pass; 5671,5673,5675,5677 West
Bavarian Pass; and 5681,5683,5685,5687 West Bavarian Pass
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
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
44
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
@
$114.40
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$228,800
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-
$1,532.25
Fire SC $228.80
STRUCTION R THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
License SC $5.00
$1,880.45
SIG OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERLY YYLIDATED THIS IS YOUR PERMIT
_ -
IT1
�� I 7 ._
:AI
S,GNATURE OF OWNER,jF OWNER BUILDERI IDATEI
BLDG SP r�AIE
1
CITY OF FRIDLEY PERMIT N :2004-01984;
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 10/26/2004
572-36U4 N'AX: (763) 571-1287
REPRINTED ON 10/26/2004
ADDRESS : 5601 W BAVARIAN PASS NE
PIN : 243024410235
LEGAL DESC : INNSBRUCK VILLAGES
: LOT 2 BLOCK 22
PERMIT TYPE : BUILDING
PROPERTY TYPE : MULTI DWELL
CONSTRUCTION TYPE : ROOFING
VALUATION : $ 21,739.00
NOTE: INSTALL PER MANUFACTWRS EIFICATIONS. INSTALL PER STATE BUILDING CODE. REROOF
BUILDING WHICH INCLUDES 5601, 5603, 5605 AND 5607 WEST BAVARIAN PASS.
STATE LICENSED CONTRACTOR 1
APPLICANT
ALLSTAR CONSTRUCTION
840173 AVE N STE 80
BROOKLYN PARK, MN 55428 -
OWNER
GASSEN MGMT CO.
I
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wort
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regula cons#)uction or the performance of construction.
BUILDING PERMIT FEE 349.25
FIRE SURCHARGE 21.74
STATE SURCHARGE, VALUE 10.87
LICENSE SURCHARGE 5.00
TOTAL 386.86
PAID WITH CHECK # 65625
Bldg Ins Date Z7 (,<�w
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
NEW [ ] CITY OF FRIDLEY Effective 4/1/2004
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763)571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: S lob 1 Ij E,5r 6 piy ,.-t v�r�
Legal Description:
Owner Name & Address: &A%bQ MANAbeAVPN,`c`r; 1!4 ic- A Tel. zZ �5-15
Contractor: Al(SMlz- n��rU'?owl rl'cr MN LICENSE#
Address: 8 q ! :a'"-'6 A 14-1 d 2i1 �K0 2 A�4 - Tel. # -3,5-7'706
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: RSP' -CSG F Ei Q /G b jA 6 --,bio I Oive r&AT
Construction Type: Estimated Cost: $ 2-1-7361
Driveway Curb Cut Width Needed::/ Ft. + 6 Ft = Ft x $ // —=$
DATE:/al d4 APPLICdNY:S 'Q ` ` �j7 Tel. # 7k5!5 35''7�G
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
$�'>c��y
Fee Schedule on Reverse Side
Plan Review
$
65% of Permit Fee
Fire Surcharge
$f
001 of Permit Valuation (1/10th%)
State Surcharge
$ /0,
$.50/$1,000 Valuation
SAC Charge
$
$1350 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Curb Cut 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
$ t� >c)�
STIPULATIONS: