AF - 45999CISY OF FRIDLEY
APPLICATION FOR PUJMBING AND GAS FITTIN6 PERMIT
y j,� ,n 'ro � . K a� Water
,� m c� 'Q s`�+ ^r � y Q .0 o. w c Heater
�j .tJ .-i � N E+ •.� �C 3+ vl � N ¢� �
-.1 61 e'J C N rC t, C1 S� .0 C � N 1d • �
11 L1 V7 G .0 �•i X .L C G 3 O .i N 1.1 N N N N .�
Q ' O '.i t� m C ul •.i 7 O O
u ^s r+ s+ ro ro •.+ ro u o.c .1 ro m� ro �d � � " as lec
N U � �.1 q y 3 ❑ G., vJ G. C� q � 3 C7 �� C7 O
, Ist
2nd
3rd
s*�:
(R) = F�sture Connection Opening Connected with Sewer
(*) = New Fir.ture, Old Opening Water
PARTIAL RATE SCHEDULE
PLLS�iBI\G FIXTURE RATES: N0. RATE TOTAL
i`i1:.:JET F].Xtt3iES
Fliture £i:cture Opening
:New Pixture, Old Ooening
Catch Basin
Watez Heater - to 99,000 STU
LGO,G�O BTU to 194,��Q BTU
water Softeaer
rew Grour:d Rar. Old Building
Electric Water Fieatez
G� FIT't'ItiG FEES:
lst 3 fixtures
Additior.al Fi:ctures
Gas Range to 199,000 BTU
REPAIRS �, ALTERATIONS
Fiist S1�O.OQ
each add. $100.00 or fraction
x S3.Q0
� x $2. 00
x $2.00
x $5.00
x $5.00
x $10.00
x $7.00
x $5.�0
x $5.00
x 53.00
x $1.00
x $�:0.00
State Surcharge
TOTAL FEE
� . REINSPECTION FEE
;$1�.00)
$
$ y o0
S
$
$
S
S
$
S
$
S
S
�
/
Job Address � � �` C � ��' � �� �? � �� �
l Department of Buildings
City of Fridley
Pel. #571-3450
$5.00 $
52.00 $
$ .50 .�
$ C�•�
The undersigned hereby makes application for a permit foz 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 tnis application are true ar.d mrrect
Fridley, Ma. � � � � `- , 19 � �
o�R O/2- r, ��G� � G� b r�--�� �
KIND OF BUILDING r- /� � �!"7 � _
USED AS j �[� /�-y 2� _
TO BE CO.^1PLETED ABOUT ( �-'�'J � E �
C
ESTIMATED COST _ _ � G^ � c --
OLD - NEW BUILDING PERMIT NO. __ PERMIT NO.
ROUGH INSP.
Date
Company i %�- f� � � ��
Signed By �-�i�.�- � CF�.-C�-� " �t��
Te l. No . �� C� i S �'= �� �
FIN1�L INSP. p � � � " � �
Date
APPROVAL I'OR P�RMIT
MINIMUM FEE POR ANY PLUMBING PERMIT IS $7.50
i
�
S60•34S0
��¢ o ���le
� �
ANOKA COUNTY
6431 UNfVERSITY AVENUE NE December 14, 1976 FRtDLEY, MINNCSOT� 55432
Minneapolis Post Office Department
Supexintendent of Delivery
lst & Marquette Avenue
Minneapolis, Minnesota 55402
Genelemen:
A
Re: Change of Address -Effective �an. l, 1977
City of Fridley
We are listing the following change of address in the City of Fridley;
NAME : Mr .& Mrs . Orvil]_e R. Gubrud
FROM: 117 - 71� Way N.E., Fridley, Mn. 55432
�p; 117 Alden Circle N.E., Fridley, Mn. 55432
LEGAL D�SCRIPTION: Part of Lot 35, Revised Aud. Sub. #77
We have not�.fied the occupant of this change and we would appreciate
it very much if you �lould change your records accordingly.
' .
Sincerely,
� !l� �
DAI'.REL G . CLARK
, Community Development Adm. .
DGC /mh
CC: City Water Billing Dept.
Cit�* Assessing Department .
Minneapolis Gas Company - Brooklyn Paxlc Office
Noxthexn�States Power Company
Noxth�aestexn Bel1 Telephone
City Voters Registration
Homeowner
(.�i� o ��idCe
� �
6431 UNIVERSITY AVENUE NE
0
Mr. & Mrs. Orville R.._ Gubrud
117 - 71� Way N.E.
Fridley, Mn._ 55432
Dear Mr. & Mrs. Gubrud:
ANOKA COUNTY
December 14, 1976
sba3aso
fRiDLEY, MINNE507A SSd21
Re: Change of House Numbers
Effective January 1, 19?7
It has been necessary for this office to change the address
of your house
FROP4 117 - 71'� Way N.E. Tp 117 Alden Circle 13.E. �
LEGAL �ESCRIPTION Part of Lot 35, Revised Aud. Sub. #77
We have notified the Post Office Department, Minneapolis Gas
Company, Nort:�ern States Power Cor.�pany, Northwestern Bell Telephone
Company and v� ious departments in City hal�l of this change.
DGC/mh
Sincerely,
- � ��
DA �L G. CLARK
Cor,imunity Development Adm.
0
.. u�-.e.,y....�,
SUBJECT •
City of Fridley 2 5 9 4 7
' , AT THE TOP Of THE TWINS g � I L D i N G P E R M I T � NO.
r
� � � O / (�
• COMMUNITY OEVELOPMENT DIV.
' j V �""
r � � PROTECT�VE INSPECTION SEC.
� � �'�'1 � C�TY HALL FRIDLE� 55�32 NUMBER REV DATE PAGE Of AVPROVEO Bv
�"""'�� ��J 612-571-3450 910-F15 4/17/98 � �
JOB ADDRESS 117 Alden Circle NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. Pt. 35 Revised Auditor`s Sub. 4677 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Monte & Kendra Gunia 117 Alden Circle NE 574-1154
3 CONTRACTOR MAI� ADDRESS ZIP PHONE LICENSE NO.
Same
e ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PHONE LICENSE IJO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION O ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Construct a 30' x 24' Dwelling Addition and a 40' x 24° Garage Addition
9 CHANGE OF USE FROM TO
SFIPULATIONS
See notations on plans.
�������
Sef�re �ig�i►�g cail fo�
a11 trtili�y ir�catiorrs
SEPAftA7'E PERMITS R�QUlRED F�� ��•�ooz
��R�IV�, IH�i?1NG, P�.��gi�G �r�Q REQUIRED 8Y LAW
SIG�S.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAO
SEPARATE PERMITS ARE REOUIRED FOR EIECTRICAL, PIUMBING, HEATING,
VENTILATING Oi; AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANO 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 ABANOONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFfSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GAHAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALl PROVISIONS OF LAWS yq�VAT10N SUiiTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHEFi SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $114,445 �S7.ZZ
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OF CANCEI THE pERMIT FEE SAC CHARGE
PROVISIO S OF NY OTHER STATE OR LOCAL LAW REGULATING CON- @
ST CTI OR P ORMANCE OF CONSTRUCTION. y+962. ZJr Fire .SCi � 11�1 .�F.S
� (�y /� � PLAN CNECK FEE TOTAL FEE
[ � y. 6
$1,133.92
S�GNATUREOPCONTRACTO�:OA.4UTHORIZEDAGEN! 1DATE1 WHEN PFiOPERIY V I ATED THIS IS YOUR PERMIT
. /� V(/ ^ � , � � �'
SiGNATURE OF OWNEA i�f OWNEA BU�LDE�71 10MTE1 8LD �NSP ��FTE
NEW
ADDN
ALTER
[]
l�'1
[]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
�����
� ��
�// �`
ConstructionAddress: �/ % �`-//�L°dt �/e
Legal Description:
Owner Name & Address: /il�NT�� 9���exi'0. G(�N� fa Tel. # �7�—l/5 �
Contractor: �c �{� MN LICENSE #
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale. �iu,G��r�y t�; '%Z� s.f'
i�'z 7?�x G�, ry �c /2. 21
DESCRIPTION OF IMPROVEMENT Z y3 �r, � =�i �`I �- �
��732 xU�, � %= yy, 3h; 2�
Length 3� Width a`t Height i� Sq. Ft.
Length �_ Width �� Height � Sq. Ft. —��'c� �c/�. Y9
Length Width Hgt/Ground Sq. Ft. "�� 7�` �'
Estimated Cost: $ � O 64 C3 /�'% �
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$
_ $
DATE: "�` (� �q�,' APPLICANT: Tel. # S 7�{ rl�
Permit Fee �
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �Z, ZS
$ �'Y. �,s'
$ ��% �Z 2
$
$
$
$
$
$
$ 33 -�Z
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.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 [ ]
. :,
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
Residential
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERA'fION AND AIR CONDITIONING SYSTEMS AND DEVICES
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditioning — All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/I ndustrial
1.25°� of Value of Appliance or Work
Rate TOTAL
$ 30.00 $ � . C�
$10.00 $ /D ��
$,o.00 �
$10.00 $
$ 25.00 $��
$
$
State Surcharge
TOTAL FEE
$ .50
._ ��
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
�uritten permission from adjoining property owner.
Effective On January 1, 1998
JOB ADDRESS � r � � � p � �( �(' (� � ,
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the Ciry Codes and
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DC��b�� � ,�sss
• - �I... � � �
BUILDING USED AS �.(y� l C�1 ��(�l C�..
ESTIMATED COST G a'� `' � PERMIT N0. /1`,°�j�G'i
�
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units � Circle One (Steam) (Hot Water) arm Air)
Trade Name J�A�•,, � Size No.�G' �y o��e `G
BTU �"o_ c�� HP r/� EDR
Fuel ,G� � G,�, Total Connected Load�?, I a'� --
,
Burner Trade Name Size No.
BTU HP EDR
HEATING CO
::Signed
FILLOUT BACK SIDE FOR ST
REPLACEMENT FURNACE
� ��r�.��������caf�or�
Tel No. �t c� � � �1
�� ��
Final Date ��
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or 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 O No O
4. Is securely supported Yes () No ()
5. Meets all current Code requirements for size
and total BTU's connected Yes O No O
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes O No O
8. Has combustion air been provided for water heater Yes () No ()
Remarks:
List ALTERATIONS Bein� Done:
HEATING CO:
Signed By:
Date:
�.
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
Residential
APPUCATION FOR POWER PIANTS AND HEATING, COOLING, VENT1LATlON,
REFRIGERATION AND AIR COND{TIONING SYSTEMS AND DEVICES
Furnace Shell and Duct Work, Bu�ner —
Also Replacement Furnace
,.(�id� �E-- � f't�! flt�-Ba�k}
a Piping (Needed with new furna� c_ e�
�
Gas Range
Gas Dryer
*Air Conditioning — AN Sizes
Afl Others/Repairs 8� Alterations (LIST ON BAC}�
1% of Value of Appliance or Work
Commercial/I ndustrial
1.25°l0 of Va1ue of Appliance or Work
Rate TOTAL
$ 30.00 $ �c3, �a
$10.00 $ `��,° o
$10.00 $
$10.00 $
$ 25.00 $ �.S°�
$
$
State Surcharge
TOTAL FEE
$ .50
���=L-tL`�
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATIONIAIR CONDI110NING PERMIT IS $25 00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditione�s can not be placed in a side yard without
written permission from adjoining property owner.
K-�`` �y�a' , __. ___ _ .
Effective On January 1; � sss
JOB ADDRESS ( G-�`,j�} G ,
The undersigned hereby makes application for a permit forthe work herein
specified agreeing to do all work in strict accordance with the City Codes and
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application ar true and correct.
T� � — � ,1998
OWNER /�lD��' C�`!/� � v4—
BUILDING USED AS_ ���
ESTIMATED COST PERMIT N0.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating U' s_� Circle One (Steamj (Hot Water) arm Air
Trade Name �eir� Size No.
BTU HP EDR
Fuel r�-$ Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
HEATING COMPANY
� � l
Signed By � �c{, Tel No. 7�`— �.S
Approved By Rough—In Date Final Date ��r
FILLOUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT �URNACE
CgIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes ( t� No ()
2.
3.
4.
5.
6
Is free from rust or deterioration
Has no foreign objects lodged within
Is securely supported .
Meets all curtent Code requirements for size
and total BTU's connected
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater
8. Has combustion air been provided for water heater
Remarks: �� Gj L���C/��
/v
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
Yes ( v)'`No ( )
Yes ( /�No ( )
Yes ( � No ( )
Yes ( � No ( )
r✓',/��
Yes ( ) No ( )
Yes � No ( )
//lGf
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572- 3604
�.µ � U�(P
Ef(ective On January 1, 1998
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FtXTURES TO BE INSTAI.IED ON EACH FLOOR
Water. Bath Wash Drink. - Floor Catch Auto. Gas Gas Misc. Water Heater
Stories Closet Urinat Tub Shower Sink' Tray Fount: ': Drain Basin Washer AppL Range Fixt. Gas Elec
Basement _ ;
Floor 1
Floor 2
Floor 3 . � .: - ---
Floor 4 —
PLUMBING FIXTURE RATES
New Fixtures
pld,Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin.
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heate� - Gas•*
Gas Range*•
NO. RATE TOTAL
/� =
Gas Dryer*• _
8ack Flow Preventer Required ()Yes () No
Type _
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTEAA'f10NS
1.5°� of Va�ue of Fixture or Appliance
State Surcharge
TOTAL FEE
y�GC�
$ .50
$-�
JOB ADDRESS l� 7 J�/u �N �� �". L�"
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and ruiings ot the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner /��( D
i �
l / � , 1998
Building Used As �O Wl,�
Estimated Cos� (,�� PERMIT NO. / J� 7 L��_
PLUMBING COMPANY � �'C'
SIGNED BY ��� TEL N0. J% -��,�
Approved By Rough-In Date � Final Date 9'�
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT tS a20.00
PLUS THE �.50 STATE SURCHARGE `
•*COM8LfS110N AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES.
SuB�ECT
c�ty of Fridley
AT THE TOP OF THE TWINS g � f� D 1 N G P E R M i T
r
� �
� ; L______ COMMUNITY DEVELOPMENT DIV.
r � � PR07ECTIVE INSPECTION SEC.
i �
i--_.�; �"' �'� CITV MA�L FRIOLE� 55�32 NVM�EN pEV O�TE
i 612-571-3450 9�0-F15 5/3/00
10B ADDRESS 117 ALDEN CIRCLE NE
t LEGAI ��7 NO. BLOCK TqACT OR AODITION
oesca. Pt 35 Revised Auditor's Subdivision 4�77
2 PROPERTY OWNEA MAIL AODiiES$ Z�P
MonteJKendra Gunia 117 Alden Circle NE
3 CON7RACTOR MAIL ADORESS Z�P
Same
a AqCHITECT OR OESIGNEii MAII AO�RESS Z�P
5 ENGINEER MAII A
PAGE OF
� �
30902
RECEIPT NO.
a�ii
�OPROVEO 8�
SEE ATTACHED
SHEET
PMONE
574-1154
PHONE LICENSE NO
PHONE IICENSE NO.
PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CIASS OF WORK
C� NEW O ADOITION ❑ ALTERATION O REPAIR O MOVE O REMOVE
B DESCAIBE WORK
Construct a 12' x 16' and 7' x 16' Deck
9 CHANGE OF USE FROM
STIPULATIONS
See notations on plan.
VVARNIIVG
Before digging call for
a�! utility locations
454-0002
REQUIRED BY LA11V
TO
SEPARATE PERMITS
REQUIRED FOR:
WIRING NEA7ING
PLUMBING� AND SIG�IS
TYPE OF CONST.
SEPARATE PERMI�S ARE REOU�RED FOR EIECTRtCAL, PLUMBING. HEATING,
VENTILATING OR AIR CONDITIONING
TNIS PERMIT BECOMES NULI AND VOID IF WORK OFi CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCEO VR!ITHIN 60 DAVS. Op IF CONS7RUC710N
OR WORK IS SUSPENDED OR ABANDONED fOR A PERIOD OF 120 DAVS AT
ANV TIME AFTER WORK IS COMMENCED NO. OWLG. UNI
I HEREBY CERTIfV THAT I MAVE READ ANO EXAMINEO TMIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE ANQ CORRECT. A�� PROVISIONS OF LAWS VALUATION
ANO ORDINANCES GOVERNING 7MIS TVVE OF WORK WILL BE COMP�IEO @2 �$58
WITH WHETHER SPECIFIED MEREIN OA NOT. THE GRANTING OF A PERMIT •P
DOES NOT PRESUME TO G1VE AUTMORITY TO VIOIATE OR CANCEL TNE pERM1T FEE
PROVISIONS OF ANY OTHER STATE OR LOCAI LAW REGULATING CON- @83.25
StRUCTION OR THE PERfORMANCE OF CONSTRUCTION W
pTUQ OF CON'a
r
N4TUAE O� OWNEA���
•Ui�OQi2ED �GEHi
i��iE� E PR(
:3-��
IDATE� L G �NS� �
OCCUPANCV
SO. fT
OCCUPANCVLOAO
CU fT.
OffSTqEET PARKING
STAILS GARAGES
SURTA%
$1.40
SAC CHARGE
Fire SC $2.85
TOTA EE
$ .50
�V � ALIOAT D MIS IS �OUQ PERb
�..��- . ��.�
NEW []
ADDN [j
ALTER [ ]
Construction Address: ��7
Legal Description: pl o F�0'7'
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
/�1��� � r
Effective 1/1/2000
(763) 572-3604 Bidg Insp
� �I b�'
2 ; c� ,�
� � ��
Owner Name & Address: ,�o�� ,F K�,��2� �l �:4 Tei. # �%`f'l�-f5�
Contractor: �C'_ I�' MN LICENSE #
Address: Tel. #
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length �T_
Length � �
i ,. �.
Wdth Height Sq. Ft.
Width ��� Hgt/Ground �_ Sq. Ft. � 9 Z
jG � �/2 tZ
G3y1 3C�rTsc:�
Construction Type: tJQe.� Estimated Cost: $ � ���V
R
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: '�� —�Q APPLICANT: Tet. # ��`f"—��
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ �, c�� Fee Schedule on Reverse Side
Fire Surcharge $ �, .001 of Permit Valuation (1/10th%)
State Surcharge $ 1, y� $.50/$1,000 Valuation
SAC Charge $ $1100 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
Sewer Main Charge
TOTAL
STIPULATIONS:
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
i�i! �
� , —
7`
���
���
��` — !b � —
;,ti,o�,,��5 �°� .
�P�'� a � �
<
� r �
(i L, _ L_,�,� R ;(,. �s��l�s ��
� ��� i 5' YV� I �V
\ m�- e mc;✓e, ��n � �
C - ` ►�c�S
� z. � _ � �e 1 l� -�o j��
a-���- H�o.�e•- o�t, l�o.:se
� �( � �os-h� .. (�T
`�.� Lo �o�s� � ' �
3 , ��td /�� ��RS �.�
t � '`f�; �+ y � "�(,�� �'ad..l`°, r�
� I:-
���ry_ i
5�`� Qt c� � r• j� L���
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MAY :E� '�� u9 � 41 �R :�Uh�HRM ;��0'ti :�'�FS 6 a.� 82�J 2760 TO 97810107
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FAX Transmittai
aunham Associates Consulting Engineers
To: Derr�etez Agro Inc. Date: 5/10/00
Attn: Montc Gunia Comm. No.:
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Fax No.: 2) 73l -Q107 Project: House Deck
Total number oi pages including tran�mittal 2 Cail sender upon receipt: Yes No
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Copies: ey: Ri.c�C Mersch, P.E.
Di�. Tel.: 952-820-1458
E-mail: rickm .Ca.dunhamassaciates.corx�.
Remarks:
Mr. Gunia
Attached is a c�py �1 the plan 1or the house deek wrhich you requ�sied.
!t yau have any questions or cnmments please contacl myseh or John Paul Gille.
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I � 1 hereby eertify that this plan, specificatio��, or report �vas prepareci Uy �ne or under my direet supervision and that (
i ry' d tt e laws of the Stat of iviinnesota
= am a duly licensed prafes�iona enbineei un er � •
� John Paul Gille
� ' Reg. No. 21476
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