AF - 38597BUILDING PERNdIT
Val.l.a.ge oi �r�dley, Minn. �� 2 5��
Date .�. .�. �:�`''. �. :"s�''� .��'. . . . . . . . . . . . . . . . . . .
Owner �� :-�.-e�� � .��-���: :��.d~:": . . . . . . Builder �;'"."��-w;`e.�.` . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address �:�t�:'+� . . .�':��: r F: : �. .�:*��?.�*;�� Address . . . . . . . . " . : ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LOCATION OF BUILDING
No. . . .�,��':�` �. . . . . Street . .��: �'',_:�`.; ,�.� .� . .�r: �:�. . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . .
.
Lot . . . . ..��. . . .. . Block . . � . . . . . . . . . . . Addition or Sub-Division .���:":�}�:`�:�:�.'`�'�. . . . . . .'�.+'�.���!�
�►
Corner Lot ............ Inside Lot ............ Setback �.�:''a�.� Sideyard �,� ��.1��'�'...........
DES�CI�IPTION OF BUILDING
To be Used as:
• ����';�.'-t'�� . . . Front ". . 5�.� . Depth . :��. . Height . . . . . . . . . Sq. Ft.�.�. �. Cu. Ft, . . . . . . . .
�
.................... Front ........ Depth ........ Height ......... Sq. Ft. ........ Cu. Ft. ........
Type of Construction „���:� ��a,�. Est Cost�,�+!'��� '�� . : � . . . . . . . . To be Completed :+.� . �e�'�?``�±� �.�.'�'.
In considerati�n 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 ia compliance with all provisions of
�rdinances of the village of Fridley.
...................................................
Tn consi�eration of the payment of a fee of $. .�`.�. ., pernut is hereby granted to �t'��1':'°��. .�d�.. .. .
..���.�.�:-�r;�-a ........ to construct the building or ad dition as described above. This permit i5 granted upon
the express conditibn that the person to whom it is granted and his agents, employees and worl�nea, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
�'ridley, Minnesota regarding loca.tion, construction, alteration; maintenance, repair and moving of bufldings with-
in the village limits and this permit may be revoked at any time uJ,pon violat� of any of the provisions of said
ordinances. ,�'"
�
.. Building Inspector
NOTICE:
This permit does nof cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or wate�. Be sure to see the Buiiding Inspector for separate permits for these items.
..+.
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City of Fridley, Minn..
BUILDING PERMIT No �-4 s s s
��
Date: ...__.��..'.� � .s� � � � � _.___.
� j,� �_ � . ��
��� - - �`.� � : � �` -` � �' �°",z
Owner: .._ _ �. .1 ,�: ...,_ ..._ ���.... uilder -------_......._._. __ �___..�....__ _..
� � �� ,r ,r-
, �
Address d ,: ry .� . . ��dre� � .t � � ------•—
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._.�'�. _ . _—_.7,----� � r�,. - _ ---�'�+!� ---------�' .._ ._ _..._ �....�.s:_�-„�_._..._
• �,....
� LOCA'��ION Of� BUILDING
���.� _ �f�' .,+�
No. - -. . ...._ Street ._ �� �x:='�::�,"°�.+`�l.�"�.._._...�e!�..�:�--•-�_.... Part g�;
� ,;r
Lot .--p�---.--...---_..-------.. Block .---------.--- �_--...._ ................: Addition or Sub-jd�ivisio ...�°T.: �
�` F"
Corner Lot' ..--------......--------.-- Inside I.flt ..---.�........ Setback ._..�._'_....: ..�.,.�- ..._f�....��i
Sewer IIevatiott
Ta � v�a �
�. �
�(��`'._�. �::.r ��..:_....
.�:
Foundation IIevation
DESCRIPTION OF BUILDING
� .
--�----� �....._.--••---- ...... -••-�--�--------------
„�, �. B „�r � ,� �,..��,-� � -,�'�r ��
Front �,�.....--7`-�-�--- Depth .;�..........--- Height .!`._...._... Sq. Ft.,,�:_.�".;c>._. Cu. F� �_....�----,�c:.,,
.......�_......_...._._..... ..:... Fron�tr _.. Depth .. ...... ef�ght ....----....../�./'� Sq. F't. ....._ ........:....... Cu. Fi.
"..�.
. � ``q.o f� �i+"jt , '�"" +i a'..a*
Zwpe of Construct�on .._ �..•,�. , � , � ::�.� �!� ...' Est. Cost .... _.�, . Jr . �';�_.:.,� . . .... To be Completed
��a �������
I'HIS PEl�P��II�I- D_',=`-: i,�'�;' T�T —I� OR!?E VIOLA I-
IC�PJ ��F r,�•!Y {�;�:;��i`,'; � L;;'dD COVERIAfJT� AR1D
. �sUfLD;iJU F��;;7F�;;.:TiC�f�JS.
In consideration of the issuance to me of a permit to construct the building descrihed above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley. _ ,�
In consideration of the payment of a fee of $.-���.....::.�:"�y..�_....., permit is hereby granted to.------...._.........--•-----••-----.....----....._..
___._._._.._._..._._.._._...____.._._..._._......_ to construct the building or additaton as descrlbed above. This permit is granted upon
the express condition that the persoa to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereoP, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, rePair and moving of buildings
within the dtq limits and this permit may be revoked at any time upon violation of any of the provIsions oP said
ordinances. _'�
r�','.,�..-� ,r!"� r !
f . :
_ .�,.: �� ��' �--,� ..::g ,f � ..�.:.-:..3--.::..�'.,Suilding Inspector
NOTICE:
Thia permit does nof eover the construeHon, inafalleHoa for wi�ing, plurobing, geu heafing, sewer or wate�. Be sure te sae
�he Building Inspaefor for separete permhs for these items.
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APPLICATION FOR BtTILDIlrTG PERMIT
CITY OF FRTDLEY, MIl�INF�SOTA
• - � ��= i ��_ r.,r r- _ .:; �� . .�a.i -.�' L�?� _
_ �,
f : � . - /. ,�/�
t � • - - - , r � .�/.ti, sin
LOCATION OF BUILDING
Nv. �`"���' Stree� <--� ��;���__��' Part of t ..._ P
I�ot � � � � Block � Addition or Sub.Di . � ��'-Y� `� ��- - �-,::=—�: �' - _
. ...✓�/ �� c� a
Corner Lot� side Lot_,_,.,_Set Ba.ck Side- , ___
SEWER ELEVATION __ FOUNDATION ELEVATION
lpplicant atfi�ch to th3s form Certi�icate a� 3urvey of Lot and propos� building
location. �
DESCRii'TION OF BUILDING
To be used ass
!
' .I�� ,, .�. ���. . � .
�
Sq. Ft. G`u. Ft.
' �'ront Depth � Hei�ht
Sq. Ft. Cu. Ft. --
�-
Type of Construction ' Estitoated Cast �f��'� ...
To be completed � �� 'd , - `� � ��^ � °
�'he underaigned hereby makes application for a permit for the �rork h�re3.rx speci�3.ed�
agreeing to do ell work in strict accordance with the City Ordinances and ruling of
the Dep�rtment of Bui].dings, and hereby declares that�all tYie facts and representa-
tiona atated in this appl�.ca.t3on are true and correct.
DATE � .� SIGNA�'URE �i����� ���; ,%��-� ���.-�---
(A Schedule of Fee costs can be found on the Reverse Side.) �
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BQILDING PERI+RIT FEE �ULE
Section 2. The Inspector of Bui].d3nga ehell, before is�uing a�q permit
for the erection of any building or struci:ure, or �or any addition tA
ar�y existing bu31d3ng or structure, or for eay elterationa or repaira
to any eaci.at3ng building or structure, upon applicat3on therefor� require
the paymeat by the applicant for such perm3t of Fees to the amount hereiu
below set forth �nd in the mazmer herein provided to�ri.t:
2.1. For any auch permit for the erection of a.ny fire-proof buildiu�, other
thaa a garage, warehouse, factory or grain eleeator, or for the erectio�ti-,:af
any fireproof addition, for s3milar occupancy, to e.�y e�d.�sting bu31d3ng `'"�
ahall be at the rate of �]../�0 for each one thousand cubic Peet, or f"raction
thereof, in such cubic�,7. c�ntenta,
2.2. Far any such permit for the erect3on of any fireproof garage, ware-
hous�, factory or gra3n elevator, or for the erection of an,y fireproof
addition, for aimilar occupe.ncy, to ang existin� building shall � at the
rate of $7..25 for each one thousand cubic feet, clasaified as "f'ireproof"
by Sect3on 502 of the Minneapolis Build3ng Code.
HOII5ES
2.3. For an� suoh permit for the erection of an
other than a garage, �rsrehouee, factorar or grain
fireproof add3tion, for eimilar occupanCy, to an
Permit �]..� for each one thousand cubic feet.
GARAGF�S
y nor�fireproof bu9.lding
e].evator, or e.r�q non-
y existiag building.
2.4. For a�r such permit for the erection of any non-fireproof gara�e,
warehou�e, faatory or �rain e].evator, or for the erection of aay non-
fireproof addit3on, for eimilar occupaacy, to e.n�r existing building or
for each auch building or addition. Ninety Cents for each one tdwusexid
cubic feet or fraction thereof, 3n the cubical contenta thareof w3th s.
mini�m�m of �L,..00. �
For the pux�pose of computing fees for buildin� permits the cubicsl contents
of any building or addition to a uniform height throughout by mtiil.tiply3n�
the ground e,rea covered from a point six (6) inches be�7.orr the f'loor li.ne of
the basement or cellar to the anerage height of the upper auriace or to the
average height of ths roof surface of the ma3n gable of a p3tched roof.
2.5. For re�irs or alterations to an exi.sting structure, the fes sha].l be
at the rate of �3.00 Por each Five Hundred Dollara ($50Q.00), or f�action
thereof in the cost of a.11 proposed work.
2.6. In no case ehall the fee charged for any perm3t ea set fort� in
Sect3on 2 be less than �L,..�.
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sua�ecr PERMIT NO.�
City of Fridley '� '� -�
ATTHETOPOFTHETWINS g�ILDING PERMIT � 22563 �
r
� � CEIPT NQ.
� • COMMUNITY DEVELOPMENT DIV. � � ��
v PROTECTIVE INSPECTION SEC.
�
r � -----;
� _ ,
� �'�'1 � CITY HALL FRIDLE� 55432 NUMBER REV. OATE PAGE OF APPROVEO BV
�--""� � �'' 612-571-345o staF15 5/26/94 / /
JOB ADDRESS 5108 Clearview St NE
t LEGAI �OT NO. BLOCK TRACT OR ADOITION SEE ATTACHED
DESCR. 2O 6 Carlson's Summit Ma SHEET
2 PROPERTY OWNER MAIL AODRESS 21P PHONE
Gerald Majeres 5108 Clearview Stree 571-4914
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAtL ADDHESS Z�P PHONE LICENSE NO.
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION X❑ REPAIR O MOVE O REMOVE
8 OESCRIBE WOHK
Reroof Dwelling & Garage (23 Squares) 2nd La er
9 CHANaE OF USE FROM TO
STIPULATIONS Roofing can be the 2nd layer but not the 3rd.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIfiED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTHUCTION
OR WORK IS SUSPENDED OR ABANDONED FOFi 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 � 1 265
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT � �.63
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEfiM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN- �31.00 Fire SC
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � 1. 27
PLAN CHECK FEE TOTAL FEE
$32.90
SIGNATUREOFCONiRACTORORAUTNORIZEOAGENT IDATEI E ROPER Y V DATED TNIS IS YOUR PERMIT
� � � S' � � �� ��
SiGNaTURE OF NEA��F O ER BUILDER� �DATEi BLDG �NS r�aTE
NEW � � Eifective 1 / 1 /94
ADDN ( � CITY OF FRIDLEY
ALTER ( j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ����
Building Permit Application
Cc�nstructicm Address: 5% v s,r �/� �.- ���� s` f iv �
Legat Descriptic�n: � °f � � �/b� /.` � �Q /- �SGN .S S�-C � � , � � n� �.�� � r
Owner Name & Address: (; � � •� /� .I dYJ /i _ j c r � 5 �S��Y � s ��y � � �) Tel. # 5 � i � /s� �
Contractor:
Adciress:
MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the progosed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARACsE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: D�'1 e o-� o/� .�/� � s� � � 6 a r� y e -� 3�. z.� �� � �` y e o"
Corner Lot [] Iaside Lot [) Ft. Yd Setback
Type of Construction:
Approx. Completian Date:
Side Yard Setbacks
/� � � � c�
EstimSted CoSt: $
(cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: S�'�- � y APPLICANT: ����:�r� � c Te1. # 5�/- 5` yi y
('ITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �/(:� c`� Fee Sch�ule on Reverse Side
$ /, �'7 .001 of Permit Valuation (1llOth%)
$ . �,� � $.50/$1,000 Valuation
$ $800 per SAC Unit
$ $5.00 (State Licensed Residential C�ntractors)
$ Alt "A° or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreemem N�y ( l Not Necessary 1 l
$ � �� � �
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any fiuilding or structure,
or for any addition to any existing building or structure, or for any alteration or repair to any existing
building or structure, upon appiication therefore, require tfie payment by the applicant for such permit
of fces to the amount herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 � � to $500
$501 to $2,000
$2,001 to $25,000
$25;001 to $50,000 • -
$50,001 to $100,000
$100,001 to $500,000
$SQ0,001 t,o $1,000,(�0 .
$1,QOQ,0p1 and up
FEFS
$15 (Minimum Fee is $15 plus surcharge)
$15 for first $500 plus $2 for each additional $1(?0 or
fraction thereof, to and including $2,000 �
.$45 for fust $2,00p pius $9 for each additional $1;000
or fractiou thereof, to and including $25,000
$252 for fust� $25,Opp p��s $(,.SO for each additional $1;000
or fraction thc�eof, t+o. and including $50,000 -.
$414.50 for first $SO,OQU plus $4.Sp for each addidonal
.$1,000 or frac�ton thereof, to aad including $100,000
$639_SO for first �$i00,0U0 plus $3.50 for each additional�
$1,000 or fraction thereof, to and inctuding -$500,000
$2039.50 for the f�rst $SOO,Opp pins $3 for each additional
$1,000 or fraction thereof, to aad including $1,IX?0,000
�3539.SU for tfie first $1,000,000 plus $2 for each additaonal
$1,OU0 or fraction �thereof -
DRIVEWAY DEPRESSION ESCROW
(Concrete G�rb Streets OnIY)
Alterna�e "A": Removal and replacement of curb and gutl;er only - Driveway width plus 6 feet times
$13_50.
Altemate "B": Removal and replacement of curb and gutxer and instau a 3 foot wide
approach with 6 inch depth - Driveway widdi plus 6 feet times $15_75_
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 houcs firom the time of application to allow
for proper review of the proposed structure and of the canstruction site.
A Certificate of Survey of the tot, showing the location of the foundation once it has it has been
constructed will be required before proceeciing with the framing.
�
Building
Inspections
763-5'�2-3604
DATE �� � ~ �
SITE ADDRESS c
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBNIIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATTON
PROPERTY TYPE
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MA
�� a ifr�f' �'� l�J �'�^ i
�OWNER ❑CONTRACTOR
�FCC• �tC�i�C� 'c�-°'oV
NAME:
STATE LICENSE #
EXP DATE
Pemut No.:
Received By:
Date Rec'd:
-�-��
ADDRESS: CiTY STATE ZIP
PHONE FAX
�SIIJGLE FAMILY/NEW CONSTRUCTI(
O TWO FAMILY/NEW CONSTRUCTION
PERMIT TYPE O ADDITIOAI ❑ GARAGE/SHED � W1N�WS
� BASEMENT FINISH � ROOF ❑ DRAIN 71LE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWWIMII�G P�L
�rYrE oF woRx:
REMODELII�iG
DESCRIBE WORK BEING DONE:_ (?_Vv��r Gi ��,C:Js C°c�n-e 1� `vY��[��r
S�ZE OF IlvIPROVEMENT
NUMBER OF SQUARES _
GARAGES
PROPOSID SIZE:
PROPOSID HEIGH'f:
SIDING
❑ Virryl
❑ Aluminum
❑ Other
wnvnows
II�f F}�STING OPENIIJGS OYes �No
OR FOR NEW OPEMNGS-DESCRIBE SIZE OF
OPENIIVG CHANGES &
TYPE OF WINDOW TO BE WSTALLED 2�
❑ HOUSE & GARAGE
O ATTACHED GARAGE
❑ DETACHED GARAGE
�Soffit
❑ Trim
❑ Fescia
LOCATIO,j�T�F,��S��/ ��
e(
NUMBER OF
HEIGHT
�ASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floar plan
3. List of structural members to be used
FL
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITTONS. & PORCI�S SUBMIT:
1. Site Plen/Survey showing ffie existing structures
and proposed project
2. Two sets of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING TI� COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATI N$ING � O- O('� �E OCCUPD ANCY TYPE
Permit Fee
Plan Review
Fire Surchatge
Surcharge
License Surchatge
SAC Chazge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Chazge
Total Dne
$
$ �5
$ �
$
$
$
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make c6ecks payable to: City of Fridley Attach
TMS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in
conforcnance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT G�,,�J i(� .�/1(� -�Il,'Y�ld��,(i, PRINT NAME .�E�AV�,('_'� C`�tn �n C2 DATE �l '�Z� �7�
Page 2- Building Residential Application
BUII..DING PERMIT FEE SCHEDULE
The Chief Building Official sha11, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or siructure, or for any alteration or repair
to any existing building or structure, 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:
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site.
A Certifica.te of Survey of the lot, shovving the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
. .
_
C17YOF
FR(DL�.Y
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
BUILDING PERMIT APPLICANT: PROPERTY OWNER
�
i, �� ������� , understand that the State of Minnesota
requires that all residential building contractors, remodelers and roofers obtain a state
license unless they qualify for a specific exemption from the licensing requirements. As
the owner of the property at _s�oBC�e�vvr�c w�� �Q_ , Fridley, I
am exempt from the state licensing requirement only if I am not building or improving
this property for purposes of resale. By signing this document, I attest to the fact that I
am improving this house for my own use and do not intend to sell it. I hereby claim to
be exempt from the state licensing requirements because I am not in the business of
building or remodeling on speculation or for resale and that the house for which I am
applying for this permit, isl the first residential structure I have built or improved in the
past 24 months. I also acknowledge that because I do not have a state license, I forfeit
any mechanic's lien rights to which I may otherwise have been entitled under Minn.
Stat. 514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to perform
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is
a misdemeanor under Minnesota law, and that I would forFeit my rights to
reimbursement from the Contractor's Recovery Fund in the event that any contractors I
hire are unlicensed.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to the City of Fridley for compliance with all
applicable building codes and city ordinances in connection with the work being
performed on this property.
Name,�Gv�Q .� ,�y�(�i � �
Date_ i—Z.� � �,