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Certificate
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LAND SURVEYORS • dVIL ENqNEQtS
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247Z Enteryr(se Drive
Mendota Hstghte, MN 5512Q
(812) 681-1914 FAX:881-9488
LAND PuNNERS . LANDSCAPE ARCHIlECIS 825 Hiqhway 10 N.E.
81ain0. MN 55434
(612) 783-1880 FAX:783-1883
of Survey for: THE RO T TL UND C011 /1PANY
House Address: 13� Christenson Court
House Model: Fulton "A"
C.I�RISTENSON CO URT
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SATELLITE LANE
e
x 9oao Denotes Exrsting Elevatlan
� Denotss Proposed Elevotion PAOPQSLA BU1LD� ELEVA770J�S
—� Denotes Dralnage Flow Dlrect►on
— Denotes Droinage dc UtNlty �oaement Goroge Slab Elevatlon: 851.9 (at door)
—o— Denotes Monument NOTE: Propos�d buHdtnq dt� groding b tn aeeadanc� wia� tn.
—�— Denotes Offset tron Beartn a shown are assumed q`°d�'9 Pb"` °�O1Od ey a,e �ty «�9a►.er.
9 NOiE: Contractor mwt vaiy o1 d�nensions k drivsrwy desiqn.
LOT 15 ,.�LOCK 1 CHRiSTE11TS0AT CROSSING
ANOKA COUNTY, MINNESOTA
We hereby certify that th(a survoey, plan or report was prepared by me or under my dtrect superviaton and that I a duly Iicensed
Land Sunreyor under the lows of the Stcte of Mtnnesota. Dated this � rrl day of J u n e A.D. 19�.
Signed: PtONEER ENGINEERING, P.A.
-"� ,���.�..
S�.' a�e : 1�= 3 4 feet BY I.�ep �
Robert B. Sikich, L.S. Reg. IVo. 14891, or
923 16190.20 TRB Terrence E. Rothenbacher. LS. Reg. No. 20595
SuBJECT , �
c�ty of Fridley � � .� ;� 9
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T '
f
� � RECEIPT NO.
� • COMMUNITV DEVELOPMENT DIV.
' j L _ �
r � � PROTECTIVE INSPECTION SEC. � �
� � �
� � /"'1 � CITY HALL FRIDLEV SS432 NUMBER REV DATE PAGE OF APPROVED BV
�"""'� � �'' 612-571-3450 9�0-F15 6/16/97 / /
J08 ADDRESS 130 Christenson Court NE
t LEGAL �OT NO. BLOCK TFACT OR ADDITION SEE ATTACHED
DESCR. 1S 1 Christenson Crossin SHEE7
2 PROPERTY OWNER MAI� ADDRESS ZIP PHONE
Rottlund Company Inc 2681 Lon Lake Rd, Roseville, MN 55113 638-0500 1335
3 CONTRACTOR MAIL ADDRESS Z�P PHONE UCENSE 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
� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR O MOVE O REMOVE
8 DESCRIBE WOFK
Construct a 42' x 25' Townhouse and a 22' x 20' Gara e
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan. Paid $350.00 Park Fee. paid Additional $25.00
Park Fee on 9/18/97
���11�6
8efere diggl�g call for
af� �tiiity :I�Catians
REQ�IRED g
�EP�IRATE PERM.t�S REQUIR'E�1 FOR , Y �W
�AtIRINC,�. NEATtNG. P,�1IMBING AND SIGNS.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVIOAD
SEPARATE PEFiMITS 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 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS 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 GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX F�Y'fl SC
AND ORDINANCES GOVERNING THIS TYPE OF WOfiK WILL BE COMPLIED 112�SOC7 �S'C).LS
WITH WHETHER SPECIFIED HEREIN OH NOT. THE GRANTING OF A PERMIT � �IIL.SI
DOES NOT PRESUME TO GIVE AUTFLORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN- @ $950.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. `P9SL. LS
PLAN CHECK FEE TOTAL FEE
� � �> License SC $5.00 $2,076.01+ PF
NATUNE OF CON7R AUTMOA�ZED AGENT �onrE� . WNEN PNOPERLY V OATE THIS IS YOU PERMI�
•�V �
/
S�GNATURE OF OWNEA�IL OWNEA BUILDERI IDATEI BLDG NSP r�qTE
NEV� � [ ]
AD�N [ l
ALTER [' ]
CITY OF FRIDLEY � �
SINGLE FAMILY A.ND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLiCATION
Effective 1/1/97
ConstructionAddress: _ ' �Q (' � �� �TEN� 4 �.-r �
I.�gal Description: �T 15 ,_ LpC.Y� �; ct..iRl�iE.�150t�1 C�� � NC�
Owner Name & Address: � N� ��� � c N� (��,4 ��,, �� I N�. Tel. #
- - —Ln ��5�0
Contractor: 51��fYlE MN LICENSE # I 3'
Address: ,7�i�$1 �.hnJ(:� 1��L� -Rcy��, ��Ev�L�E , Ml�i 5511 Tel.#_ �2�$�p�p
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:
DESCRIP'rION OF IlVIPROVEMENT
�nS'� e1�=0" Width _ �.5 ` (�" Height �
�n�h o2�? = D' Width �O'�.C�" Height $I ,_ U"
�n� Width Hgt/Ground
Sq. Ft. I% Z� j�'�('j, �y
sq. Ft. �� =1�1,3�e 9'�
s Ft. Y � � � �3�',C�,
q• r
� / /� ,��• �%
Constniction Type:_�j���, ����y ��t� Cost: $ �� yq ] . �
(Fee Schedule on Back)
Driveway Curb Cirt Width Needed: Ft. + 6 Ft = Ft x$
_$
DATE: �� GP ° Ci � APPLICANT: ; � ,
Tel. # _ �� g -� �p
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� 9��.��
$ 2, S
$_ ��.Z`�
$ %�
$ .�, �
$
$
$ t�
$ —
$ �y�c. ol
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,OQ0 Valuation
$950 `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 � �
�o��-��
. .
�
I3U[I.DIi�TG I'El�vt[T FEE SCE[EDIJLE
"['he Chief Building Of�cial sliall, before issuing perniits for the erectio» oC any building or structure, or for
an}• addition to any existing building or structure, or for any alteration or repair to any existing building or
sti�cture, 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
$1 to $500
$�O1 to $2,000
�?,0�1 to $25,000
$25,001 to $50,000
$50, 001 to $100, 000
$100,001 to $500,000
�SOO,OQl to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000 ,_
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $SU,000
$574.75 for. first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $1Q0,000
$887.25 for first $100,Q00 plus $5.00 for each additional
$1,OOO�or fraction thereof,.to and including $500,000
$2�87.25 for the first $500,000 plus $4.25 for each addidonal
$1,OQ0 or fraction thereof, to.and including $1,000,004 �
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCRO��Y
(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 FOUNDATIO\T
.
Fcrnli[s for construction will be issued a minimum of 24 hours from the time of application to allow for prop�r
re;��ie��• of the proposed structure and of the construction site.
�1 t�:����ii�icate of Survey of clic lot, sh�wing the location of the foundatio�� c�nce it has it has been construct�:!
�i�l:: ��,� rcyuired hefc�re I�r�,cecdin�� tvith the fra�ninR.
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CHIlVIlVEY AND STACB VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefiilly examined Yes (�) No ()
2. Ls free from n�st or deterioration Yes () No ()
�3. Has no foreign objects lodged within Yes () No ()
4. Is securelY �PPo� Yes i) No i)
5. Meets all current Code requirements for size
and total BTU's conn� Yes () No ()
6 Has total heating BTIJ's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes () No ()
8. Has combustion air been grovided for water heater Yes () No ()
d
�
List ALTERATIONS Being D` one:
HEATING CO:
Signed By:
Date:
��6� f 1 e�_� l�� �l�G'l �,�
0
Client:
Address:
Ciiy:
Phone:
Fax:
Comment:
Rottlund Homes
2681 Long Lake Road
Roseville, Minnesota 55113
638-0500
638-0501
YOUR BUILDER FOR LIFE
Project Name:
Reference Ciiy:
Daily Temperature Range:
Latitude:
Elevation:
�nter:
Summer:
Outdoor
D�/ Bulb
-20
95
Company:
Representative:
Address:
City:
Phone:
Fax:
Comment:
Fulto slab on grade)
mneapolis, Minnesota
Medium
44 Degrees
834 Feet
Outdoor Indoor Indoor Grains
Wet Bulb .flBLI�. D� Differ�,.enrP
N/A N/A 72 N/A
75 50% 75 36
Total Buiiding Supply CFM: 878
Square feet of room area: 2,085
u�ro �
Flare Heating � Air condi�oning, Inc.
Randy
9303 Plymouth Ave. N.
Golden Valley. Minnesota 55427
542-1166
542-3101
YOU CAN FEEL THE DIFFERENCE
CFM per square foot: 0.421
Square feet per ton: 971.676
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.. ' '.. 'C.....,.. :�.,.+•;�..:.��.;.vv..,t...i.;>�.�..�1� .�, . `i�'`:i`•:�: •:.`•y.\• ...,:•:,..•.,.• ....,r...•a`. ...`,. ...+.�,4` ..+.... t.. � ..t� �:a
,...:...:.•::•::....,......,::.;::•,'::;.,:;..;:�;:...';,,r.�'�',�t�+:.•::`:;\,•:y�;...::`.�`.;.�.:..::�.. ...........:�.... �...-... c�..csR%�s :%'2i..a$,.,.,•Et:..•,:>,:t..:•:::,.•.;E,\:...;,..;.;�\��.,;+.:�.`,�.:+�;�:>�,4••<�•;`+,.t,�:�.y;:.h•.\���.�.^�-.�.,�.??�s.�4$S�-
. :�
Total heating required with outside air. 59,658 Btuh 59.658 MBH
Totai sensible gain: 19,312 Btuh 77 %
Total latent gain: 5,812 Btuh 23 %
Total cooling required with outside air: 25,124 Btuh 2.094 Tons (based on sensible + latent)
2.146 Tons (based on 75% sensible capacity)
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+.'x.. �:. . :�. ��..'�`: A• ,,••..��'\ • 'E �\�• :`; � •gti 4 ., , ` �e�`� � , � �. .
y:.`.�::\ . � \. ,.a,! .. . �: :�`:`. \ �. ��l�. 0�.��1a`c`:,�`�. `.,...
Calculations are based on 7th edifion of ACCA Manual J.
All computed results are estimates as building use and weather may vary.
Be sure to select a unit that meets both sensible and latent loads.
�
r° Component Area Sen. Lat. Sen. Total
Description Quan Loss Gain Gain Gain
4A �ndow Double Pane � Storm Clear Glass Wood Frame 202 6,336 0 7,110 7,110
8M Glass Door pouble Clear Glass Wood Frame 40 2,028 0 1,200 1,200
11 C Door Metal Polystyrene Core 38 1,643 0 422 422
121 Wail R-19 + 1/2" Asphlt Board(R-1.3) 1,858 9,402 0 2,412 2,412
131 Part R-19 + 1/2° Asphlt Board(R-1.3) 162 410 0 134 134
16I Ceiling R-44 Insulation 1,114 2,357 0 1,127 1,127
20J Floor Over Open Crawl Carpet + R-30 14 45 0 7 7
23C SlabMlarm Duct 11/2° Edge Insulation(R-8) 26 2,392 0 0 0
23D SIabM/arm Duct 2" Edge Insulation(R-11) 130 11,123 0 0 0
Subtotals for structure: 3,584 35.736 0 12,412 12,412
Active People: 8 0 1,840 2,400 4,240
Inactive People: 0 0 0 0 0
Appliances: 0 0 300 1,200 1,500
Lighting: 0 0 0
Ductwork: 0 2,666 0 0 0
Infiltration: Winter CFM: 120.0, Summer CFM: 60.0 280 12,148 1,469 1,320 2,789
Ventilation: Winter CFM: 90.0, Summer CFM: 90.0 0 9,108 2,203 1,980 4,183
Sensible Gain Total: 19,312
Temperature Swinq Multiplier: X1.00
P-�iuiiding Load Totals: 59,658 5.812 19.312 25�124
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Total Building Supply CFM: 878 CFM per square foot: 0.421
Square feet of room area: 2�085 Square feet per ton: 971.676
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Total heabng required with outside air: 59,658 Btuh 59.658 M8H
Totai sensible gain: 19,312 Btuh 77 %
Total latent gain: 5.812 Btuh 23 %
Total cooling required with outside air: 25.124 Btuh 2.094 Tons (based on sensible + latent)
2.146 Tons (based on 75% sensible capacity)
4'•\ .
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�"Y
Calculations are based on 7th edition of ACCA Manual J.
All computed results are estimates as building use and weather may vary.
Be sure to select a unit that meets both sensible and latent loads.
;�,.A
a
i;omponent Area Sen. Lat. Sen. Total
Description Quan Loss Gain Gain Gain
4A �ndow Double Pane 8� Storm Clear Glass Wood Frame 202 6.336 0 7,11Q 7,110
8M Glass Door pouble Clear Glass Wood Frame 40 2,028 0 1,200 1,200
11 C Door Metal Polystyrene Core 38 1,643 0 422 422
121 Wall R-19 + 1/2° Asphlt Board(R-1.3) , 1,858 9,402 0 2,412 2.412
131 Part R-19 + 1/2° Asphit Board(R-1.3) 162 410 0 134 134
161 Ceiling R-44 insulation 1,114 2,357 0 1,127 1,127
20J Floor Over Open Crawl Carpet + R-30 14 45 0 7 7
23C Slab/Warm Duct 11/2" Edge Insulation(R-8) 26 2,392 0 0 0
23D Slab/Warm Duct2" Edge Insulation(R-11) 130 11,123 0 0 0
Subtotals for structure: 3,584 35,736 0 12,412 12,412
Active People: 8 0 1,840 2,400 4,240
Inactive People: 0 0 0 0 0
Appliances: 0 0 300 1,200 1.500
Lighting: 0 0 0
Ductwork: 0 2,666 0 0 0
Infiltration: Winter CFM: 120.0, Summer CFM: 60.0 280 12,148 1,469 1,320 2,789
Ventilation: Winter CFM: 90.0. Summer CFM: 90.0 0 9,108 2,203 1,980 4,183
Sensible Gain Total: 19,312
Temperature Swing Multiplier: - X1.00
s:�one Load Totals: 59,658 5,812 19,312 25,124
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Supply CFM: 878
Square feet of room area: 2,085
CFM per square foot: 0.421
Square feet per ton: 971.676
Total hea�ng required with outside air: 59,658 Btuh 59.658 MBH
Total sensible gain: 19,312 Btuh 77 %
Total latent gain: 5,812 Btuh 23 %
Total cooling required with outside air: 25,124 Btuh 2.094 Tons (based on sensible + latent)
2.146 Tons (based on 75% sensible capaciiy)
_
_
UTYOF
FRIDLEY
1=RfDLEY MUNICIPAL CENTER • 6431 UNIVERSITI' AVE. N.E. FRIDLEY. M\ 55=�32 •(61?) 571-3450 • FAX (612) 571-1287
July 30, 1997
Rottlund Company Inc
2681 Long Lake Rd
Roseville, MN 55113
Re: Park Fee Shortages for Issued Building Permits
Dear Sirs:
In checking our files we discovered that on 10 building permits
issued in Christenson Crossing, you were charged a$350.00 park fee
instead of the required $375.00 park fee which was a stipulation of
the plat approval, resulting in a total amount due of $250.00.
The addresses involved are: 121 Christenson Court NE, 128
Christenson Court NE, 130 Christenson Court NE, 133 Christenson
Court NE, 135 Christenson Court NE, 137 Christenson Court NE, 140
Christenson Court NE, 141 Christenson Court NE, 145 Christenson
Court NE, and 147 Christenson Court NE. Each building permit has
the park fee paid noted in the stipulation section.
We apologize for any inconvenience this error might cause and if
you have any questions concerning this matter, please feel free to
contact me at 572-3602.
Thank you for your prompt attention to this request.
Sinc�rely,
RON JULKOW�I
Building fficial
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CITY OF
FRIDL�Y
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, 1�1N SS432 •(61?i 571-3450 • FAX (612) 571-12ti7
September 10, 1997
Rottlund Homes
2681 I,ong Lake Rd
Roseville, MN 55113
Re: Final Inspection at 130 Christenson Court NE, Fridley, MN
Dear Sirs:
A final inspection was conducted on September 10, 1997 for the above noted townhouse. We
found that the construction of the building unit complies, to the best of our knowledge and
belief, with all �the requirements of the building cades of the City aaid the State of Minnesota
relating thereto, and permission is hereby given for the occupaaicy of said unit.
If you have any questions on this rnatter, please feel free to contact me at 572-3603.
Sincerely,
RON JU
Building
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sua�eer
City of Fridley
� 57�-���� TME TWINS �� ILDING PERMIT
� �
COMMUNITY DEVELOPMENT DIV.
i LV �'��� � ,
r � � PROTECTIVE INSPECTION SEC.
�
� _ ,
� �"'1 � CITV MALL FRIOLE� 53�92 NUMBEN REV
�'"-'�� �'' 612-571-3450 g/0-F15
JOB ADDRESS
130 Christenson Court NE
t LEGAL �OT NO. BLOCK TRACT OR ADOITION
DESCR. 1S 1 Christenson Cross
2 PFOPERTY OWNER MAIL ADOR�S$
Jean Christofferson
J CONTRACTOR MAIL ADORESS
Minnesota Exteriors 8600 Jefferson Hwv Osse
4 ARCHITECT OR DESIGNER MAIL AODRESS
5 ENGINEER MAIL AODRESS
8 USE OF BUILDING
Residential
OATE I VAGE OF
11/2/98 � �
ZIP
21P
28493
E PT NO.
����
vpOvEO Br
SEE ATTACMED
SNEET
PMONE
572-9875
PMONE LICENSE NO
) 2877
PMONE LICENSE NO.
PHpNE LICENSE NO
7 CLASS OF WOfiK
❑ NEW � ADDITION O ALTERATIpN C�c pEPAIR p MOVE O REMOVE
8 OESCRIBE WORK
Siding and fascia on west side - storm damaee
9 CHANOE OF USE FROM
STIPULATIONS
TO
Call for building wrap inspection before covering.
SEPARATE PEFMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, 'r� �r vv
VENTI�ATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NULL AND VOID If WORK OR CONSTRUCTION 20NING
AUTHORI2ED IS NOT COMMENCED V'!ITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOfi A PERIOO OF 120 DAYS A7
ANY TIME AFTER WOiiK IS COMMENCED NO. DWLG.
1 MEREBV CERTIFY THAT I HAVE READ AND �l(AMINED TMIS APP�ICATION
ANO KNOW TME SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS Of LAWS VALUATION
ANO ORDINANCES GOVERNING THIS TYPE OF WQRK WILL BE COMPLIED
WITH WHE7HER SPECIFIEO MEREIN Oii NOT. TNE GRANTING OF A pERMIT SOO
DOES NOT P AUTHORITY TO VIOLATE OR CANCEL TME pEqMIT FEE
PROV OF ANY 07HER TA7 Al LAW REGULATING CON-
UCTION OR THE PERfjO A��STRUCTION �� i_ nn
f0
/ S�GNGTUAE OF r94:AfR,'YOp Op 7C�T�IOp�ZEO AGENT ID�TEi
� S�GN4TU�7E O� OWNEp ��� OwtiEA Bui�DEQ� ibAi�i '
UNITS
FT
STALLS
iP OCCUPANCVLOAO
CU FT.
STFEE7 PARKING
IGaRnGES
$.50
SAC CHARGE
Fire C $.50
TOTAL E
2 .�0
IAT MIS IS VOUFI PERM
A �����
JUL-16-1998 11�08 FR�M CITY OF FRIDLEY TO
)DN [ � ..;+, ., ; ;: : ..: CITY.OF FRIDLEY . : . . .
,'� � l SYNGLE �FAMII:Y`-AND�DUPLEXES R•1 AND R-2
,: • , . , . . _ . BUA.�ING PERMIT APPLICATION
�
astiructionAddress:
;al Description: _
, - . . :-, . .
4933689 P.02i02
� �-��
.... . : =�����3
�ner Name & Address: � r�.� � ��_`��'�'E� TeI. �{ � �� n��%
a�txactor; ' ���,�� ,�� �,c��.� ' NSNT..�CENSE� ��
iress: . . .. � Tel. # � .
''`�' Atrach to �his applic�tio , a Certificate of Survey of the �� �
lot, with the propased construction drawn on it to scale.
rIl�iG AR�A�,:
RAG� A1�A:
Cg AREA:
EIER:
�
. . . . .... DESCRIPTION OF IlVIPROV�MENT
���.. _.. , . ... . _... �. ., ,
Length � Width � H�ight Sq. Ft.
��� • Length ��� � � � • '=� � Width � Height Sq. Ft �
Ixngth"� �•' � Width �'� H�t/Ground Sn. Ft.
�h�uc�on 1�pe: Esvmated Cos� $ �'�.�� .
�
� • � - - (Fee Schedule on Back) . , . _ •
. a�., . � . .
.:�... • ..:: .. � � .
eway Curb C�t �dth Needed: ��• � Ft:��+ 6 Fc = Ft x� � _$ �
'E: � APPLICANf� � �"�t�S � � � Tel. # �� �-�� �d, _.
� . . . .. CITY USE ONLY
ut �ee oC� D� � Fee Schedule on Reverse Side
S�rcha�ge "'� .: :: �.00! of Pennit� Valuation (il�Oth°.b)
S�C'harge � $.SU/$i,000 �Va.�uation
Chazge $ $IOOQ per SAC Unit '
ise Surchazge $ �(�[� $5.00 {State Licensed Residencial Contractors}
:way Fscrow S� AIt. "A"� or Alt. "B" Above
on Control $ $45p.00 Conservation PIan Review
Fee $ Fee Determined by Engineeriag _
r Ma.in Charge $ Agreement Necessary ( j Not Necessary []
aTAL
ULA?IONS:
$ � -�
TOTAL P.02
0