Laserfiche WebLink
CITY OF LITTLE CANADA <br />515 East Little Canada Road / Little Canada, MN 55117 <br />FILLING AND GRADING PERMIT APPLICATION <br />Applicant to complete numbered spaces only. <br />N. 1085 <br />Job Address <br />c� /P 54% 46E �/ri�C <br />Bldg. Permit No. <br />Legal <br />1 Descr. <br />Lot No. <br />Blk. Tract <br />See Attached Sheet <br />Owner <br />2 TOE- .-cre/ creR <br />Mailing Address Zip <br />3 I t _Dt-v. -cr Lti s-r/ 7 <br />Phone <br />Applicant <br />3 Sf,.v/ <br />Mailing Address <br />Zip Phone <br />Architect or Eng. Mailing Address <br />4 <br />Zip Phone <br />Contractor <br />5 <br />Mailing Address <br />Zip Phone <br />PP-0 of Fill or Excavating <br />6 I"FLoYrD2 ,4t'pr'rf <br />Type and Amount of Fill or Excavating <br />LEPEZ of ,V4eO <br />7 APE ox 15t GU VD s, <br />OF C4,4.1/4/ L-04,4 FeoM 3422 J WACC L.. <br />Special Conditions <br />8 S't cr/fl Reid CO/ cD Wc—rtzfrf.A PCZ /4/E4-rOO ay re-y- 0/4 k <br />-7- " <br />?�i'Sr1t_ D /r r. 0-Si-,92 - y�vJTt'tG < S; LT flaw . s 14-L, o't <r <br />l lrv'E OF DAL! vcry4 'ri0 N, <br />PERMIT FEE $ 3'2. <br />NOTICE <br />This permit becomes null and void if filling or grading authorized is not <br />completed within 180 days, or if filling or grading is suspended or <br />abandoned for a period of 180 days at any time after work is com- <br />menced. Any work not completed within 180 days requires a new permit. <br />I hereby certify that I have read and examined this application and <br />know the same to be true and correct. All provisions of laws and <br />ordinances governing this type of work will be complied with whether <br />specified herein or not. The granting of a permit does not presume to <br />give authority to violate or cancel the provisions of any other state or <br />local law regulating filling or grading. <br />50 cubic yards or less $15.00 <br />51 to 100 cubic yards 22.50 <br />101 to 1,000 cubic yards - $22.50 for the first 100 cubic yards, <br />plus $10.50 for each additional 100 cubic yards or fraction thereof. <br />1,001 to 10,000 cubic yards - $117.00 for the first 1,000 cubic yards, <br />plus $9.00 for each additional 1,000 cubic yards or fraction thereof, <br />10,001 to 100,000 cubic yards - $198.00 for the first 10,000 cubic <br />yards, plus $40.50 for each additional 10,000 cubic yards or fraction <br />thereof. <br />100,001 cubic yards or more - $562.50 for the first 100,000 cubic <br />yards, plus $22.50 for each additional 10,000 cubic yards or fraction <br />thereof. <br />Other Inspections and Fees: <br />1. Inspections outside of normal business hours $30.00 per hr1 <br />(minimum charge -two hours) <br />2. Reinspection fees assessed under provisions of <br />Section 305 (g) $30.00 per hr1 <br />3. Inspections for which no fee is specifically indicated$30.00 per hr1 <br />(minimum charge - one -half hour) <br />1or the total hourly cost to the jurisdiction, whichever is the greatest. <br />This cost shall include supervision, overhead, equipment, hourly wages <br />and fringe benefits of the employees involved. <br />Signature of Contractor or Authorized Agent <br />c.) p.�,._. <br />r_lature of Owner (If Owner Contractor) I/ <br />(Date) <br />(Date) <br />Building Official <br />(Date) <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />WHITE - Inspector <br />CANARY- Customer <br />PINK-Office <br />Page 16 <br />Permit Validation Ck MO Cash <br />Total Fee Collected $ <br />By <br />