AF - 42896. �� *
* PIONEEA
* ena neer
* * �*
wao suRVeroRS • c�v�
LAND PLANNERS • LANpSCAPE ARCHIIECiS
Certificate of Survey for:
House Address:
�:7
►�i
House Model:
2422 Enterprtse Drive
Mendota Helghts, MN 55120
(612) 881-1914 FAX:681-9488
625 Highway 10 N.E.
Blatne, MN 55434
(s� 2) �a3—� aso Fnx: �a3—� s8s
THE RO TTL UND COMPANY
167-177 Chrisienson Court
Ga ble Townhomes
//
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- � � CHRISiENSON CD URT
� --------------------------_-
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x eoo.o Denotes Exfsting Elevotlon
� Denotes Proposed Elewotfon
— Denotes Dralnage �►ow Dtrectfon
—� Denotes Drolnage dc Utility Easement
--o— Denoters Monument
—� Denotes Offset Iron Bearings shown are assumed
r--------�
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P.itOFOSED BUJI.D,�NG E'LEVATIONS
Garage Slab Flevation: 86p•91 (at door)
NOTE: Propos�d bu9ding aft� grading is in ourordancs with the
qradinq plans approved by the cfty enqk�eer.
NOTE: Contractor muat vaity ap dimendone k driveway dealgn.
LOTS 24-29 , BLC)CK 2 CHRISTENSON CROSSING
ANOKA COUNTY, MINNESOTA
We hereby certify that this survay, plan or report was prepared by me or under my direct supeMston and that I a duiy Iicensed
Land Survey�ar under the laws of the State of Minnesota. Dated this �� doy of V��°b�� A.D. 19�.
Signed: PIONEER ENGINEERING, P.A.
inch _ feet B �Q � �S� M�_
S e a le : 1 - 3 0 Robert B. Sikich, L.S. Reg. No. 14891 or
y.
3� 16190063 ' Terrence E. Rothenbocher, L.S. Reg. No. 20595
SUBJECT PERMIT NO.
City of Fridley � 4 � ��
AT THE TOP OF TME TWINS g U I L D I N G P E R M I T G
r
� �i y_���� COMMUNITY DEVELOPMENT DIV. REC
r � � PROTECTIVE INSPECTION SEC. �
� � �
� , �"'1 • CITY NALL FRIDLE� 55432 NUMBEH REV DATE vAGE Oc qvv vE0 Br
�""� � �'� 612-571-3450 910-F15 10/14/96 / /
JOB ADDRESS
167 Christenson Court NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2,4, �i, Christenson Crossin SHEET
2 PROPERTY OWNER MAIL ADDfiESS ZIP PHONE
The Rottlund Co. 2681 Long Lake Rd, Roseville, MN 55113 638-0500
3 CONTRACTOR MAII. ADDRESS Z�P PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
Timothy Johnson 2681 Long Lake Rd, Ro�eville MN 55113 22350
5 ENGINEER MAIL ADDRESS ZIP pHONE LICENSE NO.
ETS Inc 220 S Marion Rd, Sioux Falls, SD 57107 19015
6 USE OF BUILDING
Townhouse & Garage
7 CLASS OF WORK
C� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Construct a Townhouse & Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan. Paid Park Fee of $375.00 per unit =$2,250 Total.'
SEPARATE PERMITS ARE HEOUIREO FOfi ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV 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 CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
AND OFDINANCES GOVERNING THIS TYPE OF WORK WIIL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $650,350 (6 Units) $325. 17 (6 Units)
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �3,529.�0 �6 Ullj.tS� $.5�4��.�0 (6 Units)
�� PLAN CHECK FEE T TAL FEE
�, ��/ �k N/A F S 650. 9, 904 . 52 + PF
SiGNATU�7EOFCON'RAC Od`QRAUTHORiZEDAGENT IDATEi N P LY VALI D THIS IS VOUR PER IT
�� /� � �
SiGNATUREOFOWNEf7�iiOWNERBUILDER� iDATEi ,� LOG iN qaTE
Pre�aid Plan C�c,k $
Fstimated. �st $
Receipt #
C�Ir �, a: ��, �
I' •� I I�'�M •__ : ��I 1.y 1:
��T �v�rr ��c,AZ�v
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• - •.�,� - 1�. 1r1�r .►� _ _I � .il/�. _ _ • _ ►.. .� 11 w.
O�R & ADDRF.S.S
Architect & Address
.F�r�in�r & A�,ess _
OF WORK 6� New
[] Addition
51�0�
Effective 3/1/96
I /�,�
. .
Tel. # la3�i ' a�Jcto
�.# IqO►S
[] Alteration -Describe �(�� `�Y�►f1�1E�
• .�. . _ . - �.. �riJll[! ��,/�� , ��. - � � r1r �� �: - � � � � �
- � .
BU��IlVG DIl�&9IC�
Length � 3�' - D" Width ,yj�' � D• � Helght�' AvC�r, Sq. Ft . j �j q��# of Stories�
oFC. �: �gtr� width
Ti�SE ARE,A: T anai-h width
O'1� AREA: Length width
��! � YAL�2(�T
Height Sq. Ft.
Height Sq. Ft.
Height Sq. Ft.
Sq. Ft.,� x$ Cost/Sq. Ft. = ValUation
Sq. Ft . x$ I 8, 3 os Cost/Sq. Ft .= Ualuation
Sq. Ft. x$ Cost/Sq. Ft. = Ualuation
� � . .�
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Building Use���j�L Construction Z�pe " OccupancY GrouP :�'3
Air Conditioning �Yes ❑ No Fire Protection Provided L] Yes �No ��N��
Perforniance Bond Amaimt $ � See Reverse for Schedule Received p Yes [l No
Permit Fee $ �.�� �.. O V
Plari Gheck $
Fire ��urct��e $ �Sb.3✓�
State Surcharge $ �a�� ( 7
sAC �e � $ ,3y�• a�
Erosion Control $
Park Fee $ �Sb, DO
Spec. Assessments $ _���
Drivev�ray Esczr w $
�►rAr.� $ ✓� • �
See Fee Schedule on Reverse Side
In �ceess of Prepaid Amount - See Reverse Side
. 001 x Perniit Valuation (1/lOth o)
$.50/$1,000 Valuation (See�Sched. for > $1 Million)
$900 per SAC Unit (Plans to Nb�TTCJC for determination)
$450.00 �nservation Plan Review
Fee D2t2rm711Ed By �i n�ri tx� �%✓� Qo JC(o
Agreement IvecessaYy ❑ .Not NecessazY � ��
feet x $13.50/foot
a `
$1 t0 JOO
501 to 2,000
2,001 to 25,000
25,001 to 50,000
SO,QOl to 100,000
100,001 to 500,000
500,001 to 1,(}00,000
1,000,001 and up
$1 to 2,000
2,001 to 25,000
25,001 to 50,000
50,001 � to 100,000
100,001 to 356,000
Over $356,000
BUII,DING PERIIRI'T FEE SCHEDULE
0
$21 (Minimum Fee is $21 plus surcharge) �
$21 for lst $500 plus $2.75 for each addn'1 $100 or fraction, to and includ:
$2,000
$b2.25 for lst $2,000 plus $12.50 for each addn'1 $1,000 or fraction, to a
including $25,Opp
$349.75 for lst. $25,000 plus.$9.pp for each addn'1 $1,000 or fraction, to a
including $50,000 � -
�
$574.75 for lst $50,000 plus $6.25 for each addn'1 $1,000 or fraction, to a
including $i0p,ppp
$887.25 for lst $1�,Q00 plus $5.00 for each addn'1 $1,OOU or fraction, to a
including $500,000 - �
$2887.25 for the lst $500,000 plus $4.25 for each addn'1$1,000 or fraction,
and including $1, 000, Q00 . ,
$SU12:25 for the lst $1,00O,OOp plus $2.75 for ea.ch addn'1$1,000 or fraction
PREPAID PI,ANN CHECS FEE SCHEDULE
$29.25 �
$29.25 for lst $2,000 plus $5.85 for each addn'1$1,000 or fraction, to and
including $25,000 .
$163.80 for lst $25,000 plus $4,225 for each addn'1$1,000 or fraction, to and
including $50,000 �
$269.43 for lst�$50,000 plus $2.925 for each addn'1$1,000 or fraction, to and
including $1pp,000
$415.68 for lst $100,Q00 plus $2.275 for each addn'1$1,000 or fraction, to and
including $356,000
$1,000 (Balance due witla issuance of building permit)
PERFORMANCE BpND pOLICIES
When a building permit is issued for a commercial, industrial or a multiple dwelling residential project which require
outside improvements,a Performance Bond or a Letter of Credit shall be submitted to the City. The bond will cove
all outside improvements, including but not limited to landscaping, irrigation, curbing, blacktopping, screening fence�
lighting, and storm drainage systems. �
Calculation of bond amounts will be determined by the building permit values. The bond amount will be 3% of th
building permit value up to a 2 million dollar project or a$60,000 bond. Actual amounts wil� be rounded to the neares
$100. The City reserves the right to require greater or lesser bond amounts based on unusual circumstances. Project.
with no outside improvements, generally will not require a bond.
Bonds must remain open until the project is fully completed. All bonds will be held over one winter and through the
next growing season to insure the survival of all landsca
pe installations. The City will then inspect these propertie:
in August of the year following the initial planting, Bonds may then be released in October of that year if al
improvemenLs are satisfactorily completed.
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[[ k
CHIlVINEY AND STACB VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has l�en carefiilly examined Yes O No O
2. Is free from nist or deterioration
3. Has no foreign objects lodged witirin
4. Is securely supported
5. Meets all current Code re�uirements for size
and total BTU's conne�ted
6 Has total heating BTU's of
All other BTU's
TOTAL BTLJ's
7. Has a liner been provided for water heater
8. Has combustion air l�en grovided for water heater
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
Yes()No()
Yes()No()
Yes()No()
Yes ( ) No ( )
Yes()No()
Yes()No()
_
_
CITY OF
FRiDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UMVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
April 15, 1997
Rottlund Homes
2681 Long Lake Rd
Roseville, MN 55113
Re: Final Inspection at 167 Christenson Court NE, Fridley, MN
Dear Sirs:
A final inspection was conducted on �pril 15, 1997 for the above noted townhouse. We fo�ind .
that the construction of the building unit complies, to ttie best of our knowledge and belief, with .
all the requirements of the building codes of the City and the State of Minnesota relating thereto,
and permission is her.eby given for the occupancy of said unit.
If you have any questions on this matter, please feel free to contact me at 572-3602.
Sincerely,
RON NL OWSKI
Ghief B ' ding Official
RJ/mh .
�
5
City of Fridley
AT THE TOP OF TME TWINS
r
� .
� �
� `� __�__ COMMUMITY DEVELOPM�NT OIV.
r � � PROTECTIVE INSPECTION SEC.
�
1 = �
� �"'1 � CITY MALL FRIOLE� 53�32 N�
�----� • •'� 612-571-345p
JOB ADDRESS 167 Christenson Court NE
1 LEGAL LOT NO. BLOCK TRACT OR
DESCR.
2 PROPERTY OWNER MAII ADQRES$
Town & Country
4 ARCHITECT OR DESIGNEii
5 ENGINEER
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW
8 DESCRIBE WORK
Repair Siding
9 CHANOE Of USE FROM
�U ILDING PERMIT 2 8 8 51
1/19/99 �D� �
IBEP REV DAT6 VAGE Oi AVPROVED BY
s�aF�s / /
ODiTION SEE ATTACMED
�xx Lot 24, Bl. 2, Christenson SHEET
7910 12 Ave, Blo
MAIL ApDfiE$S
ZIP PHONE LICENSE NO
, MN 55425 545-/+233 20091282
ZIP PMONE LICENSE NO.
ZIP PMONE LICENSE NO
O ADDITION O ALTERATIpN � REPAIR O MOVE • � REMOVE
STIPULATIONS
Call for building wrap inspection before covering.
SEPARA7E PERMITS ARE REOUIRED FOR ELECTHICAL, PLUMBING. HEATINCa,
VENTILATING OR Alp CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OFi CONSTRUCTION IONING
AUTHOR12E� IS NOT COMMENCED Y�!ITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANQONED FOR A PER100 OF 12p DAYS AT "
ANV TIME AFTER WORK IS COMMENCED. ' NO. DN
I HEREBY CERTIFV TNAT I HAYE READ AND �XAMIN�D THIS APPI,ICA710N
ANO KNOW THE SAME TO BE TF]UE AND COARECT. ALL PROVISIONS OF �AW$ yp�UATi
AND ORDINANCES GOVERNING TNIS TYPE Of WORK WILL �E COMPlIEO
WITM WHETMER SPECIFIED HEfiEIN OR NOT. TME GRANTING OF A PERMIT SOO
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OFi CAMCEL THE pEqMIT
Pi70VISIONS OF ANV OTHEFi STATE OR LOCAI LAW REGULA7ING CON-
STRUCTION OR TNE PERfORMANCE Of CONSTiiUCTION 21, , I
PLAN CI
� �� �� Lice�
�GN4TUaEOFCON' CTOpOpAUTMOr+�IEOAGENT IO�tE� /
r
I
STALI.S
OCCUPANCVLOAD
CU FT.
f PARKING
GARAGES
$.50
4C CMARGE
Fire S $.50
�TAL FE
.�M � IS�VOUO PERMIT
✓ �
��FTE
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION �
.,. ��
ConstructionAddress: _� % % % "y S' / `_�� Z`- �-� `l _ r ���
e
Legal Description:
Effective 1/1/99
r� � ��1
.0 �� o�
� �r
Owner Name & Address: Tel. #
Contractor: �c� a y� �'�u H.�'•�,i NIN LICENSE �o?�o j/?8Z
Address: 'Jy/0 /vZ � ,�ic �°,��o� ��o�. �s� .SSYo7S Tel. # ,5�.� - 5�z33
Attach to this apnlicarion, a Certificate of 5urvey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
r Od}
Construcdon Type: /'Y��<r S�r,��'.� Estimated Cost: $ S��
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �- / y- 5 j APPLICANT: j.y'f�i� g .-� .� .¢ �/ Tel. # yo s-aio -� Si3
�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �?l o0
$ ��
$ �
$
$ S ��
$
$
$
$
$ � �7 v�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Pemnit Valuation (1 / l Oth %)
$.SO/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.� Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
Sue�eGr
City of Fridley
AT THE TOP OF THE TWINS g U i L D I N G P E R M I T
i �
� �
� `V �_��� COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
1 � i
, ����: � CITY NALL FRIDLE� SS1� NUMBEii NEV DATE VAGE
�'""'� � �'' b12-571-34b0 s�aF�S 3/5/99 /
JOB ADDRESS 167,� 169, 171, 173, 175, 177 Christenson Court NE
1 LEGAL LO7 NO. BLOCK TRACT Oii ADDITION
oesca. 24 to 29 2 Christenson Crossing
2 PROPERTV OWNER MAIL ADORES$ ZIP PI
Rottlund Townhomes
Oi
/
28984
RECEIP O.
���
APPROVED BY
SEE ATTACMED
SMEET
3 CONTRACTOR MAIL ADORESS ZIP PHONE LICENSE NO
Town & Country Roofing 7910 12 Ave S, Bloomington, MN 55425 545-4233
4 ARCNITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
545-4233
5 ENGINEER MAIL AODRESS 21P pNONE LICENSE NO
8 USE OF BUILDING
Townhomes
7 CLASS OF WOFiK
❑ NEW 0 ADDITION � ALTERATION �7 FiEPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof Building (90 Sq.) Tear-off
9 CHAN(3E OF USE FROM
STIPULATIONS
TO
Underlayment must comply with the State Building Code.
tYPE OF CON;
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRiCAL, PLUMBING, MEATING,
VENTILATING OR AIR CONDITIONING.
TMIS PERMIT BECOMES NUIL ANO VOID IF WONK Ofi CONSTRUCTION 20NING
AUTHOqIZED IS NOT COMMENCED WITNIN 80 OAYS. OR IF CONSTqUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERI00 OP 120 DAYS AT
ANY TIME AFTER WOiiK IS COMMENCED. NO. DWIG. l
1 HEREBY CEqTIfV THAT I MAVE 1iEAD AND E%AMINEO THIS APPLICATION
ANO KNOW TME SAME TO BE TiiUE AND CORRECT. ALL PROVISIONS OF �AWS VALUATION
AND ORDINANCES GOVERNING 7MIS TYPE OF WORK WILL BE COMPLIED 713
WITM WHETMEq SPECIFIEO HEREIN OR NOT. TME GRAN?ING OF A PERMIT $7�
OOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OFi CANCEL TME pERM17fEE
PROVISIONS OF ANY OTMER STA7E OR LOCAI LAW REGUTATING coN• �137.ZS
STRUCTION OR TNE PERfORMANCE OF CONSTRUCTION
PIAN CMECK
3 c'S Lice
S�GNATUpEOFCON'NACTO ORAUTMOp�ZEOaGENT IDATE� u ei
� iD�iEi
SQ.
STALLS
I
GROUP �OCCUPANCY�OAD
CU fT.
OFFSTFEET PARNIN(
IGARAGES
$3.86
{AC CNARGE
Fire SC $7.71
L FEE
153.82
� THIS VOUR P RM
� � � �� `
Mar-04-99 05:47P P.04
NISW � � � a:uwuva, u a� �v
ADDN [ � CITY OF I�'RIDLEY
ALTLR [) SINGLE FAMYLY AND DUPLEX�S R-1 AND R-2 �
BUILDING PERMIT APPLICA'Y'ION n �
,�/ � � �o
C�nstructionAddress:,f�� ,%ri's7G� sd✓� /�/ L � �
].,egal Description:
Owner Name & Adciress:
Contractor:
Address:
LIVING AREA:
�r��Te1. �/
.MN LICENSE #� jL� / �.S�a
/ � o? Te�. /i _/ yS � �1� �3 3
Attach to this application, a Certif'icate of Survey of the
loc, wich the proposed consuuction drawn on it to scale.
DESCRIPTION OF TMPROVEM�NT
Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Ixngth Width Hgt/Ground Sq. Ft.
OTHER: �'4�
�� /��
Cons�ruction Type:/�(,�V �T7' � � aD� Estimated Cost: $ ,r�=�-��-°��` � � �
fFee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft �c $ _$
DATE: APPLICANT: Tel. �,�'�/ � � �/� � �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
i,icense Surcharge
Driveway Escrow
Erosian Control
Park Fee
Sewer Main Charg�
•roTAL
STIPULATIONS:
$ /372�
$ �• 7�
� 3, �
$
$ �� �
$
$
$
$
$ /53� �2
CITi' USE ONL'Y
Fee Schedule on Reverse Side
.Ofll of Permit Valuation (1ilOth%)
$.SO/$1,000 Valuadon
$1000 per SAC Unit
$5.04 (Sta[e Licensed Res�den�ial Contractors)
Alt. "A" or Alt. "B" Above
$450.OQ Conservation Plan Review
Fee Determined by Engineering
Agreernent Necessary [ ] Not Necessary [ ]
�
ADDRESS
PIN
LEGAL DESC
�CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
►63) 572-3604 FAX: (763) 571-1287
: 167 CHRISTENSON CT NE
: 143024320213
: UNAVAILABLE
: LOT 24 BLOCK 2
PERMIT NO.: 200402304
DATE ISSUED: 12/20/2004
1 • �
�. �
PERMIT TYPE : ELECTRICAL
PROPERTY TYPE : COMMERCIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. PH:763-784-3729
1;1 # INSPECTIONS
# 0-100 AMP CIRCUITS 2 # 101+ AMP CIRCUITS
APPLICANT
LAZER ELECTRIC
8164 ARTHIJR STREET N.E
SPRING LAKE PARK, MN 55432
(763) 784-3729
OWNER
GITTLEMAN MANAGEMENT CORP.
167 CHRISTENSON CT NE
FRIDLEY, MN 55432 �
AGREEMENT AND SWORN STATEMENT
This petmit 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 wor�
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
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date
ELEC PERMIT FEE - MIN (NON-RESI)
ELEC AMP SERVICE FEE
ELEC CIRCUIT FEE (0-100 AMPS)
ELEC CIRCUIT FEE (101+ AMPS)
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 42761
SEPARATE PE�RMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0
0
0.00
30.00
� �b "�
0.00
0.50
42.50