PRE 2010 DOCSVillage of Fridley, Minn.
BUILDING PERMIT
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Date: ..................................
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Owner y�/."..����`;�'"' .•.. � Builder ...
Address (%. ... ...... ........ Address
`
�LOC,,n4T�ON OF UILDING
No. Street .(e.`..d✓'.�,c`�. ........... Part of t ...
Lot ...1 ....... Block .. ..........
Corner Lot ........... Inside Lot .......
i -on or Sub -Division .. .... %
Setback ..... Sideyard/®.ei2/��—�/
D CRIP N OF BUILDING
T%o� be Used as:
A� f ........
Front .�. Depth h����% Sq. Ft.� . Cu. Ft.
..... F nt ........ Depth Heig t ... Sq. Ft. ........ Cu. Ft. ........
Type of Construction Est. Co '..?.11� .. • • . • To be Completed A. ............. .
In consideration of the issuance to me of a permit Letr&jtjd
t des cribed above, I agree to do
the proposed work in accordance with the description b e ompliance with all provisions of
ordinances of the village of Fridley.
In consideration of the payment of a fee of $. . ........ permit is hereby grante p!4f• .. .
......................... to construct the building or addition as described above. This p46mit isgranted 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, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. _ I-%
Eff - s®
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing,
sewer or water. Be sure to see the Building Inspector for separate permits for these items. ,,
City of Fridley, Minn.. N° 7584
BUILDING PERMIT
•
Date: May 27s 1965
per: Dean Keller Builder Home Service Co.
Address 642 63rd, Avenue N. E. Address 110 Arcade St. St. Fauls Nin,
LOCATION OF BUILDING
No. 692 Street 63rd. kmnue N. E. Part of Lot
Lot 9 _ Block 9 Addition or Sub-DivisionM -St+ie Add.
Corner Lot _ Inside Lot _ _ Setback — Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front Depth Height Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Est. Cost $4,M.00 _ -- To be Completed
• Storm Dma$e Repair
•
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 a& provisions of
ordinances oY the city of Fridley. /�49,�
In consideration of the payment of a fee of 10 • 00 , permit is hereby granted togs Service C •
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, construction, alteration, maintenance, repair and moving of buildings
wior thi ncesthe city limits and permit may be revoked at any time upon violation of any of the provisions of said
NOTICE
IYs pem b den not cam the construction, hntaWan for wkb& plumbing, gas hsatb & sewer or water. Be suns to as
the Building Inspector for separate permits for thea itenm
APPLICATION FOR BUILDING PIM IT
CITY OF FRIDLEY, MINITESCTA
OWNER'S NANE-J&a-� BUILDER
ADDRESSja-4?"ij�� ADDRESS
LOCATION OF BUILDING
No. (� I+Z, Street (I ":? a,, " -A> %- Part of Lot
Lot Block Addition or Subdivision - _
Corner Lot Inside Lo Setback Side Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates.
To be used as:
DESCRIPTION OF BUILDING
Front iaaLh Height
Sq, Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Costes ---'
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,tound on the Reverse Side).
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City of Fridley, Minn.
BUILDING PERMIT
Date: AUGUST 3, 1965
zff-- �9r9(
N® 8306
Owner: DEAN KEUAR Builder SUSSEL COMPANY
Address 692 - 63rd Avenue N. E. Address 1850 Como ky-enue
Fridley 21, Minnesota St. Paul, Minnesota
LOCATION OF BUILDING
No 692 Street 63rd Avenue N. E. part of Lot
Lot Block Addition or Sub -Division
Corner Lot _ Inside Lot.__ Setback Sideyard
Sewer Elevation — Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Det. Garage Front 22 Depth 24 Height 10 Sq. Ft, 528 cu, Ft 5.280
Front Depth height Sq. Ft. Cu. Ft.
Type of Construction Est Cost 41.n.2D4.. O - 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 orth and in compliance with a& provisions of
ordinances of the city of Fridley. V ,
00
In consideration of the payment of a fee of , permit is hereby granted to SUSSEL GARAGE
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 location, construction, alteration, maintenance, repair and moving of buildings
within
nnthe city ]'mita � permit may be revoked at any time upon violation of any of the provisions of said
ALLEN G. JENSEN Building Bator
NOTICE
'lido pwmb dow no emw the cendmedw, hata&dm #w wbhi% pbmbhm an hathm sewer w wrier. Be etre to an
thn Bwmbg r for aperato pwaft for than hens.
OWNER'S NAME
APPLICATi& FOR 46zDING PERMIT
CITY OF: FRTtL MINNESOTA
ADDRESS_ `- ' Al � ° ADDRESS
LOCATIONOF BUILDING
N'o.�(� ��, Street ��r. �N/ mart of Lot,_,
LOT BLOCK ADDITION OR,SUBDIVISION
Corney Lot inside LOT` Setback Side-*
tard
SEWER ELEVATION FDUNDATION"ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates+
DESCRIPTION'OF i�iDING
To be used as:
Depth_.Seight
Front
Sq. Ft.--�/ Cu. Ft.
Front Dept _Height"
Type of Construction
To be completed
Sq: Ft. Cu. Ft. : • .. .
77 t7.
4//1, Estimated Cost y�%�
The undersigned hereby`kakes 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., grid -Hereby declares that all.'the facts
and representations' stated -'fn this application'�a e° ,true °and correct.-
DATE
orrect.DATE
(Schedule of Fee Costs can be found on the Reverse Side).
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LOT
NAME
SIZE
-DEA
BLOCK
ADDRESS
VALVA
3 Y� IY, ,E.
{y/ .a`
ADD'N. --]
AREA
TYPE
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5--84-S915.51
City ®f Fridley
Application
Dept. of Bldgs. Phone SM -3490
DESCRIPTION OF WORK 692 N E 63rd Ave
Number, Kind and Location of Fixtures Bon
{
Number Fixtures ...... .. . .......
x $2.00 $
Future Fixture Opening .... .... ....
x $1.50 $
New Fixture Old Opening ...... ..
x $1.50 $
Catch Basin ....... .......
x $3.25 $
Water Heater (Up to 99,000 BTU) ....
x $3.00 $
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WATER HTR.
GAS FITTING FEES:
NO. RATE TOTAL
lot 3 Fixtures ..........................
x $2.00 $
7
O F
Lias Range to 199,000 BTU ..............
en
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I S
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GAS
ELEC.
Base
lot
Int
a
T
ci
eerator oz
is
de
2nd
3rd
--
4th _ --
° Fanfare Conmectlon Openings Connected with
Mow Fixture, Old OpeningsSewer C]I
Cesspool ❑
PARTIAL RATE SCHEDULE
PLUMBING 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 Heater (Up to 99,000 BTU) ....
x $3.00 $
New Ground Run Old Bldg.
x $3.25 $
Electric Water Heater
x $2.00 $
GAS FITTING FEES:
NO. RATE TOTAL
lot 3 Fixtures ..........................
x $2.00 $
Additional Fixtures . ..................
x $ .75 $
Lias Range to 199,000 BTU ..............
x $5.00 $
G -s Incinerator
1 5.00
REPAIRS h ALTERATIONS—Refer to Coda
Description...................................I............$
TOTAL FEE $ 5.00
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__ 6-12-70 19_
Owner Dean Keller
Kind of Building frames
Used as res
To be completed about 6-17-70
Estimated Cost, $ 10.00
Old—New. Building Permit NI–q • -Lp,*//it
ito
ROU01
FINAL 9 � 6
Business Phcne
I
HW' Mayor Uebl*City IWASer & City Engineer
nw:+fir Clarence Witte - Builder lus"et
MI`' ' April 13, 1913
Ict Usiding at 692 s 63rd Avduue biX.
Johnson BuIldLUS Mort contmtor
An 1"pection was made an April. 11s 1912 of the above addrems followin
0 COOPISint from the Omer. Our recovda indicate no mit was obtained
for the r+idiAS. work that was done at this address.
Th -a Wpection showed to 013401 of Ow a idiu& vem not caulked ;at the
doors and vindove which 10 a coda viclation inn that, water eouia enter th-4&
straq,%-rre and cause +detariorati.
The owner feels that the metal soffit is not adequately "cured in some
areal bit ue Una no specific provisions for foottming of Mxch mater%1 ae
611004=e 10 always made for expwsiov and contraction. The owaor iudicaro
the rap. from 'tai word vas not 40l up or r moped fry site as p
the em t between th a the cont star.
940 office feels the. contractor should be held . ap ible for the
vivlctiooa butt will gait for &MOtiou from higher authority ty as to what
proo,04ure we should follow to gaju eompl gn".
Tie contractor was licev#04 to the perms fram .April 30, ,1971 to Agri
30,, 1972 duvina vhIch time 4a work was done at this citta.
EUMFE SUM
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MEM a' hl,-Eit3�-Manager & City Enginedr
MEMO FROM: Clarence Belisle - Building Inspector
MEMO DATE: Apr i1- 13- - MU
RE: Residing at 692 - 63rd Avenue N.E.
Johnson Building Mart Contractor
An inspection was made on April 11, 1972 of the above address following
a complaint from the owner. Our records indicate no permit was obtained
for the residing work that was done at this address.
The inspection showed the ends of the siding were not caulked at the
doors and windows which is a code violation in that water could enter this
structure and cause deterioration.
The owner feels that the metal soffit is not adequately secured in some
areas but we have no specific provisions for fastening of such material as
allowance is always made for expansion and contraction. The owner indicated
the scrap from this work was not cleaned up or removed from the site as per
the agreement between them and the contractor.
This office feels the contractor should be held responsible for the
violations froprt-h-igh6r authority as -to what"
procedure we.should follow to gain compliance.
t caaact.Qr was licensed for the period from April 30, 1971 to April
302 1972 during which time the work was done at this site.
C NCE BELISLE
Building Inspector
CB /mh j/ 7
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16 10 �Q
City of Fridley, Minn_ I I 't 3 u
6431 University Ave. N. E., Minneapolis, Minn. 55,132
BUILDING PERMIT
Mate: May 16,. 1972
QypxW; _ nPan Kellar Builder Johnson Building Mart
Address 692 -63rd Avenue N.E. Address 3615 East Lake Street
No 692 Street
Lot 9 Block
LOCATION OF BUILDING
63rd Avenue N.E.
0
_— Part of Lot
Christie Addition
Addition or Sub -Division
Corner Lot inside Lot Setback — _ Sideyard
Bawer Elevation Foundation Elevation _
DESCRIPTION OF BUILDING
To be Used as:
Re -side Front Depth Height _ _ _ Sq. Ft. _ _ ____ Cu. Ft.
Front Depth Height Sq. Ft. __ Cu. Ft.
Type of Construction Aluminum Est. Cost _$23400.00 —__Tobe Completed Complete
In consideration of the issuance to me of a permit to construct the building des above, I agree to do
'the proposed work in accordance with the description above set forth an plian with all provisions of
ordinances of the city of Fridley.
1.20 State Surcharge
r
In consideration of thepaymentof a fee of $ 30.00DF -permit is hereby granted to Johnson Building Mart
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, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
ceps. city limits and this permit may be revoked at any time upon violation of any of the provisions of said
d' k/ ...e �td� AM Inspector
CLARENCE BELISLE
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these Items.
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
LOWNER'S NAME: BUILDER: "hij C'L
ADDRESS: Gj �' o� - l0 34 6 ak/L(`,J ADDRESS: (n /mS (S a g_b .
NO:. 9aLJ STREET
LOT: BLOCK: ADDITION: 0
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
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:
Front: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; \—Cubic Feet:
Type of Construction: �XQ$iY►1 t%r(i1�vyU Estimated Cost:
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in stfict 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
--
(See Reverse Side For Additional Information.)
53-84-9915051
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
RATE
a
N%=ber Fixtures
x
$3.00
o
Future Fixture Opening
x
d
S'
Water
x
$2.00
S
Catch Basin
x
$5.00
E
t
p
x
pN'p{,
$
IV 14
x
$10.00
$
Water Softener
Heater
w
a
m
.ei
rs
x
$5.00
$
Electric Water Heater -
•i
$5.00
w
a
U
of
of
u
-1
a
a
o
$
�p m
w m
m
q
18C
H
-4
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N
3
G W
N
W
a iQ
K$
C7
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O
a8
$4
Ast
2nd
3rd
4th4th
(R) - Future Connection Opening
Connected with Sewer
(•) - New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
N%=ber Fixtures
x
$3.00
S
Future Fixture Opening
x
$2.00
S'
New Fixture, Old Opening
x
$2.00
S
Catch Basin
x
$5.00
$
t Water Heater - to 99,000 BTU,
x
$5.00
$
100400 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7.90
$
New Ground Run Old Building
x
$5.00
$
Electric Water Heater -
x
$5.00
$
GAS FITTING FEES:
1st 3 fixtures x $3.00 S
Additional Fixtures x $1.00 $
.Gas Range to 199,000 BTU x $10.00 S
REPAIRS $ ALTERATIONS
First $100.00 $5.00 $
each add. 5100.00 or fraction $2.00 $
State Surcharge $ .50
TOTAL FEE $ 8.00
REINSPECTION FEE
($30.00)
Job Address . 692 63 eve. NE
Department of Buildings
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the work herei
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 cors
Fridley, Mn. 12-16-76 , 19
OWNER nRAN KELLE
KIND OF BUILDING frame
USED AS res
TO BE COLLETED ABOUT 12-23-76
ESTIMATED COST 10.00
OLD - NEW BUILDING PERMIT NO. PERMIT NO. OP
Company
Signed By �flIAIN.E�A�
Tel. No.
ROUGH INSP.
Date
FINAL INSP. <1-199
Date
APPROVAL FOR PERMIT dilca
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50
P.m
SUBJECT
of Fridley
172000
AT THE TOP OF THE TWINS
BUILDING PERMIT
rpCity
R
'
r. y__ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 �
i CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910-F15
6/9/83
10B ADDRESS 692 - 63rd Avenue N. E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
9
9
1 Christie Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Dean Keller 692 - 63rd Avenue N.E. 571-1456
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Ev's Construction 10931 Kumquat, Coon Rapids 755-2494
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF Bl ILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Reroof Structure and enlarge doorways
9 CHANGE OF USE FROM TO
STIPULATIONS
Roof can be 2nd layer but not 3rd. Install ridged galvanized valleys.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Asphalt
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
$4,000
2
$ ��
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMITFEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATIN CON-
$44.50
T UCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$46.50
SIGN URE OF CONTRACTORORWAII.RIIEDAGENT IDATEI
WHEN PROPER VALIDATED THIS IS YOUR PERMIT
a E
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
P.m
CITY OF FItIDLCY Effective Aug. 1, 1981
APPLICAT194 FOR RESIDENTIAL BU1LDIiIG PEFU41TS
(New, Alterations, Additions, or Repairs)
OWNER: kaztlil-
ADDRESS: �7✓ �!"� /l� /�
TEL A0: I I�
STRIMT NO: (O [ STREET:
LOT: I? BLOCK:
BUILDER:
ADDRESS:
TEL 110: ✓£' 057 l
Construction Location
J�4 at, -e --
ADDITION: cg s77L wlk) -
Corner Lot: Inside Lot: Setback.: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
Front: Depth: H eight :
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: Estimated Cost: $ eco
Zb Be (bripleted:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE PSVF.RSE SIDE OF SHEET .
9iie 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: v►v�� � SIGNATUIE :
Stimulations:
a
F�
sueJEcr
City of Fridley
i�718�27
AT THE TOP OF THE TWINS
BUILDING
PERMIT'
ERMIT
r
R 5Q EIPT N0.
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
p
zo
r PROTECTIVE
Op Q
1 �
`
1 """1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
5/13/86
JOB ADDRESS 692 - 63rd Avenue N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
9
9
Christie
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Dean Keller 692 - 63rd Avenae N.E.
571-1456
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
X0 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 12' x 10' Shed
9 CHANGEOFUSEFROM
TO
STIPULATIONS
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
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
$.74
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,472
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.
$25.00
PLAN CHECK FEE
TOTAL FEE
$25.74
SI ATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
,WHEN PROPERLY I TED T $ IS YOUR IT
BLDG )NSP r) TE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
F�
NEW [ ] City of Fridley Effective 4/1/86
ADDN. [ ] �R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address: a 7A (0 - /� /-� o
Legal Description: Z- 0 G��.%�� 6'6--A/ %��0�'l,S'j /;,I=
Owner Name & Address: ��_ A& 4f, !:IL 11E A G' Tel • #
Contractor: Tel. #
Address:
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.
/ 9 /'C/,
Z' /j:
OTHER:
Corner Lot [ ] Inside
Lot [ ]
Ft. Yd. Setback
Side Yard Setback
Type of Construction:
Estimated Cost: $
Approx. Completion Date:
Alt. A
Alt B
Proposed Driveway Width
If New Opening Is Desired:
$
$
See Back Page for Explanation
—
�%^- C
Tel.
✓��l �/ ��
DATE: O (o APPLICANT:
��
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$475 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
CITY OF FRIDLEY
Effective Date May 1, 1988
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
RESIDENTIAL
Furnace Shell and Duct Work,
Burner (Also replacement furnace)
Gas Piping
(piping needed with new furnace)
Gas Range
Gas Dryer
* Air Conditioning (all sizes)
All Others/Repairs and Alterations
1% of Value of Appliance or work
COMMERCIAL/INDUSTRIAL
1% of Value of Appliance or Work
RATE TOTAL Job Address 692 63rd Ave NE
$ 20.00
$
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
City of Fridley
$ '10.00
$
Tel. #571-3450.
$ 10.00
$
The undersigned hereby makes application for a permit for the work herein
$ 10.00
$
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.
10.00
$ 10.00
Fridley, Minn. July 719 89
OWNER Dean & Mary Keller, Sr.
KIND OF BUILDING Frame
USED AS Residential
State Surcharge
TOTAL FEE
Reinspection Fee ($15.00)
DESCRIPTION OF FURNACE/BURNER
"INSTALLING ONE (1) CARRIER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
38TH024 2 TON AIR CONDITIONER
Trade Name Size No.
Rough Insp.
Date
Final Insp.
Dat
Approval for Permi
$ .50
$ 15.50
TO BE COMPLETED ABOUT
ESTIMATED COST $ 1500.00
OLD - NEW BUILDING PERMIT NO. PERMIT NO. :dlQ
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00,
PLUS $.50 STATE SURCHARGE
Attach stack verification form with.replacement furnace permits
*Air Conditioners can not be placed in side yard without
written permission frau adjoining neighbor.
Capacity
Total Connected Load
BURNER - Trade Name
Capacity
Sq. Ft. EDR BTU
Kind of Fuel
Size No.
HP
Sq. Ft. EDR BTU HP
Company ,Dependable / Heating and A/C
� `
Signed By n .6 l°
Tel. No. 757-5040
SUBJECT
City of Fridley
26471
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
�• _ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
9�
NUMBER
REVDATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
7/7/98
JOB ADDRESS 692 63 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
9
9
Christie Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Dean/Mary Lou Keller 692 63 Avenue NE
571-1456
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Great Northern Resources Inc 10026 University Ave
NW, Coon Ra ids, MN 784-0162
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
20117027
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (22 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
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
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
$1,834
$•92
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-
$59.50
Fire SC $1.83
STRUCTIO OYTH PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
License SC
$5.00
$67.25
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI
WHEN PROPE VA 1DATED THIS IS YOUR PERMIT
v
BLAG INSP
DATE
SIGNATURE OF OWNER,IF OWNER BUILDER) (DATEI
JUL-66-1996 15;24 FROM CITY OF FRIDLEY TO 7688864 F.01/02
AUDN [ ] CITY OF FHYDLEY
ALTER (] SWGLE FAMILY -AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION 0"(p
ConstructionAddress:
Legal Description:
Owner Name_& Address: • Tel. # S7 J —
Contractor: LICENSE #�
Address:.. el. #
Attach to this appli on, a Certificate of Survey o e
lot, with the proposed construction drawn on it to scale.
DESCRI MON OF EUPROVENM
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width HgVround Sq. Ft.
Construction Type:1AJ1Z'4d'1Z_Estimated Cast: $
(Fee 9chedu2e on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ m $
DATE: 7 APPLI Tel. #���
Permit Fee $_
Fire Surcharge
$
State Surcharge
$
SAC Charge
$
License Surcharge
$ _
Driveway Escrow
$
Erosion Control
$
park Fee
$
Sewer Main Charge
$
TOTAL
$ IO
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/101%)
$.50/$1,000 Valuation
$1000 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
SUBJECT
PE - .'.
City of Fridley
3 0 042
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
• _ __ COMMUNITY DEVELOPMENT DIV.
SEC.
r PROTECTIVE INSPECTION
080
I CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910-F15
8/11/99
JOB ADDRESS 692 63rd Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
9
g
Christie Addn.
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Mary & Dean Keller
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
G. W. Construction 7949 Lee Ave N Brooklyn Pk 55443
566-4065
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 ?§X REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reside house and garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Call for building wrap inspection before covering
SEPARATE PERMITS ARE REQUIRED 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
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
3800
$1.90
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTIO THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTALFEE
Licens C 5.0
.95
- SIMAT2E OF CO AACTOR OR AUTHOPK0 AGENT (DA Tr
ENP OP
LIDATE ISI IT,//yj�9
IIATf
S,GNATURE OF OWNEROF OWNER BUILDERS IDATE,
BL IN$P
NEW[ ] Effective 5/10/99
ADDN L ] CITY OF FRIDLEY ®U y
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name & Address: Qa, l, g,,,r/@ten ,(;,�� Tel. #
Contractor: �'. G'o s '� MN LICENSE # .T"pe 0 -2
Address: 2Lor tvu �h ,�,� -3'5 W,7 Tel. # 5io6`.S
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: Le W th Hgt/Ground Sq. Ft.
OTHER: !�Eslb E �� o
Construction Type: Estimated Cost: $ aeo
Driveway Curb Cut Width Needed:
x
Ft. + 6 Ft = Ft x $
ME
DATE: APPLICANT: Tel.
CITY USE ONLY
Permit Fee
$ ""2s
Fire Surcharge
$ 3-36
State Surcharge
$
SAC Charge
$
License Surcharge,
$-
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL
STIPULATIONS:
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 [ ]
•
SUBJECT
City of Fridley
3 2 0 9 7•
AT THE TOP OF THE TWINS
BUILDING PERM
-
RE
1 _ _ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
(��®�
f � � PROTECTIVE
NUMBER
REV
DATE
PAGE OF
APPROVED BY
1"'1 CITY HALL FRIDLEY 55432
�'""�"�
612-571-3450
910415
8/23/01
JOB ADDRESS 692 63rd Avenue
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
1 9
9
Christie Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Mary Keller, 692 63rd Avenue, Fridley, MN 55432 763-571-1456
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Window Lite Home Improvement, 8400 89th AVe N, B.P., MN 763-425-2227 20039258
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
C NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
B DESCRIBE WORK
Install new patio door _& bow window
9 CHANGE OF USE FROM TO
STIPULATIONS
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. Caulking
& flashing for all exterior openings.
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
Y
ANY TIME AFTER WORK IS COMMENCED. '
NO DWLG. UNITS
OFFSTREET PARKING
1 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
$6986.00
3.49
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-
License $5.00
Fire SC $6.99
STRU OR THE PERFO CE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
$154.73
SIGNATURE OF CO ACTOR OR AUTHORIZED AGENT IDATEI
H PROPERLY VALIDATED THIS I�9�
0 INSP -
S-GNATURE OF OWNER -IF OWNER BUILDERI IDATEI
NEW [ ] ( ocpz CIT04
40kH
ADDN [ ] CrrY OF FRIDLEY
ALTIER SINGLE FAMILY AND DUPLEXES R-1 AND R-2
1`tiA BUILDING PERMIT APPLICATION
ConstructionAddress: (n 0- ,1 -
Effective 1/1/99
/9/. /�
�6 Lk-� Q -
Legal Description: U
Owner Name & Address: - Peace Tel. #
Contractor: MN LICENSE
Address: $ - 41 Tel. # %(,3- 2,---2�
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:
Construction Type: 1)\kz Estimated Cost: $ (, ? neo 6c�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: F APPLICANT: Tel.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee $
Sewer Main Charge
TOTAL
STIPULATIONS:
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
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
SUBJECT
PERMIT NO.
City of Fridley16
AT THE TOP OF THE TWINS
B U I L D I N G P E R M I T
r
`
COMMUNITY DEVELOPMENT DIV.
�"
572®Z04
CEIP
_
S
r PROTECTIVE INSPECTION SEC.
1 � �
REV
GATE
PAGE OF
APPROVED 8Y
l A fir'-',•� CITY HAIL FRIDLEY 55432NUMBER
.---
L J` 612-571-3450
9t 0415
9/17/01
JOB ADDRESS 692 63 Ave NE
I LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
9
9
Christie Addn SHEET
2 PROPERTY OWNER MAIL ADORES$
ZIP PHONE
Dean/Mary Keller 692 63 Avenue NE
763-571-1456
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Window Lite Home Improvements, Crosstown N Bus Cntr #4, Brooklyn Park, MN 55445
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
763-391-8314 20039258
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK n
❑ NEW ❑ ADDITION ❑ ALTERATION % REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace 1 patio door and 1 bow window
9 CHANGEOFUSEFROM
TO
STIPULATIONS
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.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING. HEATING.
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
q
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$3,414
$1.71
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•
Ae
ST=RTHE CONSTRUCTION
$9.7.25
SC $3.41
7CEEF
PLAN CHECK FEE
OTAL FEE
242--0/
Lice e ISC
107.37
S-GNATURE OF CON • ACTOR OR AUTHORIZED AGENT IDATEi
HE PRO VAL ED THIS I UR PERMIT
S-GNATURE OF OWNERoF OWNER BwLDERt iOAiEI
G INSP fgAtE
NEW [ ] Effective 1/1/99
ADDN [ ]CM OF FRIDLEY `-
ALTER [ ] I I v SINGLE FAAMY AND DUPLEXES R-1 AND R -2 --
BUILDING PERMIT APPLICATION ,+1 02
ConstuctionAllress: (oq a W r-cL A Ut.
Legal Description:
Owner Name & Address: Oeo-n F- rm v -LA 1����u - Sa/rn2 Q 'Tel. # (76;;) 57 / -/'x-15 (o
Contractor: WINDOW LITE Home Imp rovements MN LICENSE #
Address:
n Nurin Business Mr. # 4 Tel. # 934
Suite 460 -8400 -Oft Ave. North
Brooklyn RMAW040lication, a Certificate of Survey of the
o.
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:
6O
Construction Type: Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: 01— 5-0 I APPLICANT: Tel. # 7 3 aJ �2a7
CITY USE ONLY
Permit Fee
$ q 7• d--5
Fee Schedule on Reverse Side
Fire Surcharge
$ /
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC Unit
License Surcharge
$ 06
$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 $ D
STIPULATIONS: