AF - 45160� �
�
,� ��� � � � y
> � � x
�� �p "
p������
: �� � � � �
: x° °p � �
O � .
0
: � � : :
: M . .
. � . . .
� � : : :
� � : . .
o�
� �
� •
{g {fl
�
e�
�
r
F+
�
0
-�
�
N
�
m
0
iC SE p4 •
n� r �
O O O �
�89 {A
� O
G �0
r
�
a
� � � � � z x
a � � a �
�� ���
ox� ��
d �
� � � � �
� � • ¢ � � �
0 p ' � !-�
R' N : � �' � y�
bd o ' °q •
� p . � . .
O ' • •
: � ; : : :
: � : : : :
0
>C �! k �4 iS p4 •
w n� w � r. r�.. �
w O C7� O O O
{fl ffl f!i tA ifl �fi9 �
0
r
�r,
��
�
a�
>
�
i
D
'�
m
�
�
_
PI7
C
r
m
� � � o p ••
� � y
7y � �
8
�°
m�O
R. p
'� '�
� �
�
� m
8�
� � � y � �
� °p�' R' �e
Vi y
8 � � l�d
� o � �
� � � �
� � � �
g
� I �
�
1
�
�
WATER
�
���
�TM
�u�s
eAS1N5
SINKS
WA9i
ranrs
DRINK.
FOUNT.
�.
FLOOR
DRAINS
��
e�siNs
nuro
w�
GAS
APPL
GAS
RANGE
GA$
OPENINGS
� �
2 !
� �
�
m
n A
w
a �n � �'
� '� o
� °��� �
��� �
, ��� � :�
o � �� �
��° �
� ��.o�
�� �
� �� ��
� ����.
�
����
�
�
���m
p �
w o
� �� �
@ � o
M y
���w
�
I� m
���.�
�o���
f! � � y
����
�. � �
-�+pp�7
�
r+ r. .. N
I I � M N
� � � �
�
�
—�
�
m �
�N
� �
� H
aM
A �
&�
0
p �
��
M
� a
� , �
�
�
�i
�
�
3 n
� �
� _,
�
� C-
� � � a
t'�► 1� �
� �� M
� �
��
� � a'
b � A
a
�� 1�'
0
�
�� �
� �
�.
�
�
�
�
r
0
�
�
N
(r
�
y � ro �
� � �
� t�~+ �i O
� x
G
x���
� O
RP � � �
� � � �'
�M��
W
`Y,'
y
�n
�
o �
� �
�
�
V`
a
p
�
�
�
m
�
�
�
�
G
�
,
�
x
�
�
N
� � y H
m� `+ ►`�°�
� � �
� � �
°o °= � �
o���
� �
o�
9 '
O � .
o .
� : :
� : :
x
�e ,e �a o
� �
� C O �
fA {!i {fl �
� O
C� r
o�
I
�
�
�
�
0
H f�
° �
�
�'. w
o �
�
�
a c
w Q
c
�
;�
�
�
�
�, �
� �
�'
x
;�
�
�
o�
�
�
�
�
�
0
0
0
O
0
�
w
0
0
{f!
�
�
0
r
a
�
C i
"�g O
w
� w
��
� �
M �
y
� �
�:
�.
� •
� •
m:
��
� =
R. �
� �
� �
0
.�
v
1
.�
0
�
�
� �
��
o �
� O
�
0
O
�3
�
�
�
x°
O
�n
0
�
�
w w �
��
M
aa `D `D :C
w t� L�-Y ,�s�' ,,0,�
o °o � � �
� � � � �
� � � � �
W
��o k
x ��
� � o 0
� o
�� :�,�
H ' � a�
. ; � �
: : o tn
: ' �', �'
: � �
: � :
N N � �
en ea o 0
O O O O
{�'T �! �69 fH
0 �
z.�
� �
F�+ y
�
� �
oa
�
� c
� '
O
�
� � � � �
��� ��
R° R° � � v� �
�'
� � � � �
� �0
� � d '�
�°���
e� p
�' �' � � "�
m
� s� : s�
� � ; � �
q . • �
� � . . O
O
� � � � �
�
� � � � �
o °o . °o $ °o
{fl {ii {A {�
o � � �
c. p`D, p
m �'
� � K
O (H'
� ���
�
� �'
g _ �i
m �
� �
m
�
�
�
� S
�° ,� ,�
� � � n k
� �
f� R° � � �
� m
� � o �
� � � �
�o d�
����
m � � �
�' � �
�, � :
�,�. .
�, . .
� � ; '
O � , �
Cp . .
O . . .
N � � � �
0 0° o° °
O
�
�
�
w
aa �
��R'� °w
a�q�� �
o��y �
.�
� d�
�* �,
�� o
����
5' � ��
�~'H �.
�, bi �'
����
����
pv' �-�* w
m�
���p
�"�,o
� � � �'
��'�.�
����
���y
���
��O
� �
co ty.
� �
� s� �•
�
>
�
�
�
�
m
H
_
m
C
r
m
d
�,�+
�
�
�
�
Q
�
A
0
E
� �
�
�
�b
'��
��
�i
�
�
�
�
`•
�
� �
� �
� �t0
.��u'1
��.
O.:i�
v<
e. �
��
�i
70
�
�
�.
�
�
0.
� �-
�,
�
Caty of Fridley, Minn.
BUILDING PERMIT
Date: — Au� . 11, 196 9
p�r; McAmis g��. Sussel Co.
pd� 16 0 Gardena N. E. Addx.ess 1850 Como Ave.
G/ G �
N° 10365
LOCATION OF BUILDING
No. 1640 g�t Gardena N. E. � p� op �t
�W.� of 36_ gl� Addition or Sub-Divisian Auditor's Sub. �92
Corner Lot _ Inside Lot
Sewer IIevatian
Setback � Sideyard
�.— Fotmdat3on IIevation
DESCRIPTION OF BUILDING
To � vsea as:
Fami 1 y Rc�,cYm F3'OIIt ��.� Depth �._� HEight �_ Sq. Ft. �.8 C:u. Ft �-�_
�Yont Depth %Teight Sq. Ft, Cu, Ft,
1j�pe of Construction Frame �, �^� _ To be Completed Nov. 1969
— 3600.00
In can�lderation oP the 3ssuance to me of a permft to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all pravisfons of
ortiinances of the dty oP Fridley. � L �ir � �� ` � � _ � �
Ia con�fderation oP the payment oP a fee of $ '14 _ OQ , permit fs hereby graated to Sussel Co .
to construct the buflding or addition as desc:ribed above. Tbfs �-p�� t fs granted upon
the express condition that thepers n to whom it fs granted and lua agents, employees an� worl�nen, ia ali work
done in, around and upon said building, or any part thereoP, shall coffiorm 9n all respects to the ordinanc2� oP
FridleY� Minnesota regarafng location, construction, alteration, maintenance, repair and. moving of buildinga
wltt�in the dty limits and this permft anay be revoked at any time upon violation of aay of the provisiona of said
ordinances.
�� BuildinBInspector
Henxv . Muhich
n NOTICEs -
T66 permh doas no1 eevsr f6s wns�rneHoe, installatioa tm vririeg, p�umbine, 0a heatieg, ssanr or wate�. 6� sun 10 �
�fia Buitdle� le�e� for separaf� parmh� fo� t6as Ihmt.
c •
n � _ -�
APPLIC9TION FOR BIIILDING PERMIT
CITY OF FBIDLEY9 MINNESOTA .. ...
OWNEC�'S N.AME �C AMIS BIIII�DER ( �+� �USSEL: �p
��xESS 1�4� GA����r� N. C, �n�x�ss � a so ��MO �� �AUL
LOCATION OF BIIILDING
NOo 1(04b STREEi' �A�-��N�4 i✓. E.
� LOT��� ��f BLOCK ADDTTION OR SiTBDIVISION �Q�e�ir�rz'S �a� 9p'Z
CORNER LOT INSIDE LOT %� SE°I'BACK SIDEYARD
SEWER ELEVgTION TOP OF FOOTING
Applicant a�tach to this £or� Two Certificates of Survey of Lot and
proposed buildin� location drawn on these Certificateso
DESCRIPTION OF BIIILDING
To Be IIaed ga:
�,a � � 4 ir ?�► Front I 4/ Depth I Z� Height i O`
,, Square feet ��� Cubic Fe�t l~%Ob
Fxont Depth Height
Square feet Cubie Feet
Type of Conetruction 4-Z� r✓i � Estimated Coat ��, (oDD �-°
To �e Completed j(�oV�rr�c3,ETL (�j�� ��y jvss�'L�
The undersig�.ed hereby makea application for a permit for the work
herein epecified, agreeing to do all work in etrict accordance with the
Ci.ty of Fridley Ordinances and ruli.nga of the Department o� Buildin.gs,
and hexpby declares tha,t all the facts and representationa stated in
thie application are true and correcte
�H� �USSE � � o ._ ay
DATE S'( l- Co � S 3GNgTURE �,�'p,,�., �,(�A���,,,
(Schedul,e of Fee Costs can be fouta.d on the Rever�e Sideo)
� �� � - �.2 - .� -,
3/s y Z >�
fG � c .�'�: — � - � � ..._ �
- � '�
n �
S & �1
!. �
�
g =
li 1 1 ''JI' 'JI iI'311 1'�F
SECTIO1V.2o The Inspector of Buildings �hall, before is�uixig permit�
for the e�ection of axzy building or �t�u.eture9 or ior any addition to any
c��i�tin.g �tructure or build�rsg9 or .for a.t�.y altera,tion o� repa.irs to asiy
exiating bui� di�.ag os� �t�uctuxe 9 upo� �.pplieation. therefore 9 requi.re the
gayment by the �.pplica:rst fo?� euch. pe�it oi fee� to the amouta.t herein
below aet io�th and in the ma.�taer here�xs provided tomwit:
IIniform Build�n� Codeo Type 19 29 & 4-$1075 ior each one thousand
cubic feet9 0� iraction thereoi9 ir �uch cubical c:ontentsa Type 3& 5-
$1a50 for each one thousar�.d cubic fe�to
For the purpose of computing fees for buildi.ng permita, the cubical
- �'t�nt$ of-��Y�`cl�d.�i�"��. ui'��form hei:�it+'��t�o'CCt_.�,�,.._, _
multiplyiizg the ground area covered from a poirt six (6) inches below
the iloor line of the basement or the cellar to the average height of
the upper surface or to the avera.ge height o� the roof surface of the
ma.in. gable of a pitched roof o
For repairs or alteration.a to arA eacietir� atructuse, the fee shall be
at the �ate of $3.00 per each f'ive hur�.dred dollars ($500000) or
fraction thereoi ila the cost of all �roposed wor°ka
I.n no ea�e shall the fee charged io� axiy p��mit ae aet forth in Section
2 be less than $5a00o ' ,
NSSSD Coxzn.ection Chaxges ba�ed oti location - Area 1 or 2 e
I
I'"1 /"',
, :� �
.
_ � , y
� ' ,
t � , �1
� _
�
�
�
0
n
�
�
• N ,
� ��
� ��
n q �
�
�
i V'
I�l
n
� ��
o ��
� �
Z
��
E; b
`� � n
'� o T
��
� ��
����
�`: � >
�I� <
,� �
_ � - � � � -�i
r �� � i
�� � � �
� �
l �
s
f
-
D
. _
�, .
�
;
1
i
,
0
0
25/3Z" SNE,/�71-!/�•/t-, -
Z x CD S/�..L /�. GbNT,
�Zw .G� . �. - (o� o�G _
Z x�ii- 57'CJI>S - 1 Co�� o/c
56" UN�Er'zl�IYM�G-N7'
-3¢" �,cJ3 - �L.C�2.
2 x � o �O/ ST -/G," o��
. ,
. . ' � '� � .
�..'.� ,y• �, .
b ;: .
. I • _. • . , fi _3¢" .5TY2o- F0.�1M
� �.� . . , ki P�2/M�7+�2 /NSUL .
. . - ,Q ;i
. i'
.� � " .
_ G, <ZAL� � _ _ _ . . ' b . �j ;'. .
� � , • _ � _; G21► W C..
. , D. .� , . S�.QG-E
'.G �'. �
I. = � . • `'� •
'� � �. �� . . �
. � ', i • '� • ,. .
. i . ' . . �,
� 'y� . ' .
. '� . `, ,b' . . .
a ' P . .
. ,�, , � , 8" �on.rG. BLKS. .
N ' . •c �
�' , p ' , .
� • . D .
b , p . .
� . � ,
i � �a
. . b.
. •b , .
. D. ' • . e � � .
. .� � ,
0' . • P ' • . d • , , .
, . , .
'� 4;D ' h • ',`, '� ' � .
. . . � , p .
/ . � . � h � ,� . .� � -- 3 - �2 �� � c4NT.
� G..�.'i�::/�5;'�w� � :s..`�� �.. � � � �
i�'�t..�t�i�""'�'���� - _ �- - .
. �,
- , r"'� %Y/?�GLI L JSG G7/O�_
- _ No sc��-� - _
Y
'� ' i .
�
�
�
.. f
�
a
! � °
�
a �
. _.... _.... /,I� , �._. .._;��r,�.-. .- x.�mr _.
\
� ,
�� /
J�
. ;`
7'
; �, �. . e
�. �
�� �
� Ui
�i (P�
;
�
I
�
r x v
m Z �
y� �' m rn �,
� � � � �
r �
� � � ��
o �� n
z � �
� �
z � Z
� � U
�� � � �
z m � 8
Z z �
�� '� o �9 W ('
� ;� , � � w
i�
I � �
eii -
v
a , p
n
r�� �
1
P
f ,, . .
y ,
Jr
�
�
� ;
�
�
:� '
n
�
m ,
Z �
�I
�
� i
, '
-�
Q
.a
��
�
� � �
� �
O � � � � � � � Z �
a � � � �
� , � � � � � � � � � � �
� � � �
� r � .. � � � `F' � � � �
• � S � � � � ; � � � � �
: � � , �s � o � -� � �
• m
�� � � � � .�
..
w �� vs � • • a ° � � m �
. .
!y I-�• .�� � � . . . {� � • �' •
CD Iy '�'� � � ° �' � � .� � •
� e � • o
� y b � � . . . • . o �
. . e . m• .
m *i £ r� : : • , • � •
� • i� . . o m o e :
w . : . . : . . e m
• • . e : a e o
� �' . . . .
i-~� q • � •
cw+ q�j� OQ . . . . . . e o e o
O � �
r� '
�
• O �
�
: M M M M M M� M �t al 11
�' 8 � 8.�8� 8 � � a � �
�; ��°
, N M � M a� p "°
� O I � �
o . a �
� � � I �
�
�
,..�
�
�
�
�
�
�
�
�
�
��
�
�
>
�
r
7D
�
T
�
�
�
�
�
ir�
i-
3 . �•;�� _ -
li :i, �
. �'� _
. . ���_��
� . ��: ��
: ; �,�'� �
�i�� ��''— "�'�'
o � � e �
�. �
' � � � Et :
��� �
�� �
�
�
� � � �
� �
� �
" �
.�
�
�
�
�
�o�
���
vr.�v�
�I�II.
��.
s��
��
�eeaatas
��
�ww�
�
�
�
�
�
� .
��� �
� �� �
�
��,�
����
����
� � �' � �
a. �
� ����
��� �
� ���
�€��
� ��
� � ��
m��
����
�
N �� �
�, � �
��
��
���.
�� ..
����
����
��
� ��
� �-
e ���
�
�
��
�e�
�
��
� �
�S Ri
p �
� �
�
�
.
n
�
�.
� �
� �
� `�
�.
�
�
� w
� �
� �
,
�
�
�
�
�
m
;:
�;' ,
, .?�.°� ��� �� �������
I^� � 6431 UPlIV�R�tTY A�/EPIlJ� N.�., FF3IDL�Y� tdI1NNESOTA 654�e^
A..__ ..-.;.y 9 .
, �'� TELEPWONE ( 812)571•345tY
;� S�ptember 4, 1�80
�
�
;:'
,' ,
� � Mr. Sid Gordon
Sussel Company, Inc.
1850 Como Avenue
St. Paul, MN 55108
• Re: Building Permit Application at 1640 Gardena Avenue N.E.
Dear Mr. Gordon:
A permit site inspeation was corzducted on Sept�nber 3, 1980 of 1640
Gardena. Avenue N.E. It appears that the existing garage is approximately
five feet from the west lot line.
Your proposed addition is an axtension to the rear of the existing
garage and would also then be five feet from the west line. As you
know, the City side yard setback for living area is ten feet. Therefore,
we will not issue the building permit until the proposed addition is
altered Lo yive the required 10 foot min:�um setback or a variance is
granted to go closer than ten feet.
Tf you have any questions on this matter, please call me at 571-34500
Sincerely,
D T G. CLARK.
Chief Building Official
DGC/mh
CC: Keith I�IcAmis
1640 Gardena Avenue N.E.
sus�ecr PERMIT N
City of Fridley 15 9 5 7
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � R .
' COMMUNITY DEVELOPMENT DIV.
� �ti: -
r � ' � PROTECTIVE INSPECTION SEC.
� . �
i__-- � ��'���;,, CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
L J\ 6� 2-571-3450 910-F15 10 3/80 � �
JOB ADDRESS
1640 Gardena Avenue N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. P�t Of 3 Aud. S11b. #92 SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Keith McAmis 1640 Gardena. Avenue N.E. 571- 8
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Sussel Com an 1850 Como v
4 ARCHITECTORDESIGNER MAILADDRESS 21P PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
R
7 CLASS OF WORK
❑ NEW 0 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
� �
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE �'ER�iITS �EQLII�ED ��R VVt�OKii�t�,
HEATIfdt�, Pt»UMBING AI�D SI�iA��
� �IVJ�RNI�G
Before digging cal! locat uiilities
TELEPHOl�E - ELECTRIC - GAS Cb�
REC�l1iRED �Y LA�'°
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. W�CZ FT3ILle
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 DAYS AT 2%O
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APP�ICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDI ANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO.
WITH WH T ER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $8.375 yS`4.19
DOES N T RESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISI OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
TRUCTI OR THE PERFORMANCE OF CONSTRUCTION. S5�-.00
�) PLAN CHECKFEE TOTALFEE
� ����� 6�
�`°�� $12. 75 $67. 94
�S� TUREOFCONTRnCT'�R RAUTHORIZEDAGENT IDATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
� �'� P �- �'� � - � C�Q� i� ,� '
SIGNATUREOFOWNERiIFOWNERBUILDERi IDATEI BLDG �NSP TE
I
I
�
�
��
CI3Y �F Ff�,IDL.EY � •
ARPLICtITION FOR RESIDENTIAL QUILDIPdG PERMITS
(PJew, A1�er�tians, Addiiions, or Repairs)
9
+ ,,
� 1 I
� �_..��1 ' �.
, � � . � ��: :���; �� �: /`
� � ` .
,� �
�UIl.DER;
ADDRESS:
TEL N0:
Construction Location
STRE�7.' NO : �� �� STREE� -
�����
L07.': �� BLOCi;:
ADDITION;
�
r �r
Corner Lot: Inside Lot: Setback: �� Sideyards:
Applicant attach to thi.s form two Certiiicates of Survey of 1ot and
proposed building location drawn on certificates to scale.
DESCR�PTIO�J OF CONSTRUCTION �
Front: _��� Dep�; �/ Height: �
Sciva�e. Feetr txibic Feet:
. Front: � Depth; Heigh�:
Square� Feet: Cubic Feet: �
Type of Construction:
� Be Cbmpleted: �� ���
-r-'----
. C� �
Estimated Cost: ,
. . � Alt. A p�,lt. B
.Proposed Driveway Width If New Opening Is Desired; �• $ �
• � . SEE REVERSE SIDE OF SHEET
The undersigned hereby makes application for a permit for the w�ork herein speciiied,
agreeing to do all work in strict accordance with the City oi Fridley Ordii�-uir.es and
rulings of the Department of Buildings, and hereby declares i:hat ail the facts and
xepresentations s�ated in this applicatia are true an d c rect.
DATE: �� !�i p D SIGNATURE: �
5tipulations: � � •
�', , � �
�� � ��
���1
. � ��►�� a
.
(� �•�`-0 � 3/ . �
�
� �-�� . .
�
BUILDI(JG PER��IIT 1=�� SCHEDULE�
S�CTION 2. The 7n:;l�ector. of 13�xilding� sha]J., bef.ore i::suing }?er.miL-� for the erecLion
af any }�uiJ.ding or :�L-ructure, or for any addi_tion to any exi�t•ing buildiny or struct.ure,
cir for any a,ltcration oz rc},�airs L•o •any exi�L-ing bui.ldS.l�g or sL-z-ucturc, up�n applic:ation
L•hezetorc, requirc L•he paymenti bX tlie a�plican� for. such permiL of L-ces to, t}ie amount
hcrein below seL- forL-h and in tiie manncr herei.n provided L-o-wiL-: _ '
I�FaT CONSTP.UCTIDN: Single ramily Fiomes and Gazages: $�.00/l,OQO cubi.c ieet.
�'7�N CJI3:CFc: ?.5 percent of I-�ui.l ding �ermit tee. � - ,
DRIVEZ�JAY D�PRI:S5IOI1: (Concrete, Curb Si:rcets Only)
• - Altern��te A: Rc:mov�.l and replacement- of concret� curb and
guti:er only; Driveway width plus 6 fcet x Y�,�+e 75
Alternate B: Removal and xcplacement of concxete curb and
� gutter and install a 3 foat �vide anproaeh with
6 inch depth; Driveway width �plus 6 feet x$17.85
� ADDITIQN/�L I�FOR�IATION
ror the purpose of computi.ng fees for building p�rmits, the cubica]. contents of any
buil.ding or aadition, is determined by rnultiplyi.n5 the ground area covered iram a
pai.nt six (G) inches below th� floor line of the basement or th� cellar to the
average iieights of the upper surface ox to the average height of the roaf suriace
oi 'the raain gabl.e of a pitched roof .
For x'epairs or alterations to an existang strUCture, the �ee shall be at the rate
oi $3.00 �er each five hundrea do].lars �($�00.00) or fraction ihereof in the. cos�
oi all groposec? work. � °
In �no case shal.l the fee charged far any pe�nit as s�t���orth in Section 2 be less
than $7.50 plus $.50 state surcharge. .
, � e;��RIFICATIO� OF F�UNDATION
NOTE: �i'ermits For constru.ction will be issued e m�Q m�una s�cturesand of the �e
o� applicai�ion to allow for proper review nf th p 1� �
constnie�ion site. , , .
A Cer�.ificate of Survey of the lot, showing the location ot the foundation once it
has been construc�ed wi11•be required before proceeding with the fra�►�5'
C ' � ���
-
A�plication for a Cert.ificate of Occupancy shall be made ten (10) days prior to the
use �r occupsncy Qi any structure ior which a building p��i'� has been i.ssued; and
said structure shalJ. no� be used ar occupied until a Cerl�ifica�.e of Occu�ancy has
Ueen xssued. �
,
� s i
3 �
. � ' .
� . � .
. .,-�s+!r. .. .
NORTH
�
�
295 �
��
% �` �
�B �
SI� A�D�E38
.
.
�� �
EXTFRIOR �NVFLVPE AVFRAG� "U" COMPI,(TATIDN
_�
v
�
2
CONTR�lCTO� l � F c.� � _P ! C � , DATE . �� . ��'� PHONE (y-,��.�' �`�� �
���o �__
....�..�..�..�
DETERMINE WORKING SQUARE FOOTAHE OF EACH
1. Total exp�sed wall erea ... .. .. .. �2 �,�' _�� Sq. Ft. x .185 0 (� Z,
.
—...—� �
2. ToteZ roof / ceilfng area ....... �!'�Q � Sq. Ft. x .04 � C.�
. .,�,,,.,_-.. � , `a�,
TOTA�. EXPOSED WALL AREA AHOVE FI,OOR m �
. DET'ERMIt�E "TJ" VAT,UE OF EACH WALL SEGMENT
g nUe�
b•• �OCAZ W911 i411i16�OW aY@8 m�������������• �il�i�� � � `�� � ,�.-m.�....�.�...
. Totel door erea ...................... " �
— 1'��`t � -'_��fF�:' ....
' c. Tota1 elidin� glaee door a�ea o . . . , . . , g . . _ , � .�:_��3.
d. Totel fir�place wall aree ......�..... X � � �
e. Total wail framin� area ( average 10%) � � � I 1� � �����
�. Total n�t wall eree above floor ....., . ��,��+�q� � ���¢. -.�
g. Tot�l sim joiet are� ................ �9 il� X—. �.�.� �� �
' -� �. .,_�s -��. r�.�.
TOTAL EXpOSED FOUNDATION AREA =' � ��
_-.-�!1,
�. Tot�l fo�adetion window area ........� � X � Q �
i. Total a�t foundation area above grede ��,�I g_�;�.�.. �..
� �•-�q�� ��i���
3 � � � � � � � � � � � � � � s � a e � � e � � � � � � � � � � � � � � � � � • • � a � � � s � � � � • a � � � o • • � • • � � � s � � � � � � � � � 1V iL1L �� � �
If �it�m 43 is ttae e�e a�, oz lese than item �il, you have �et the intent oE
88C 6006 (C) 2.
s
1`OTAL EXpOSED IiQOF / CEILING AREA m ��Q
. • DE1°�RMI�1E "U01 VAI,UE �°OR EACH ROOF / CEILING SEGAiENT�
j. TOt�l.ekylight 8rea ..........�.o .............. � 1eU�� .. .
k. To�a�l. sa�of/e�ili�g freming area ( evex�a�e 10�) � g •� o..� -
1. Total n�t i�rsl�t�sd roof/ceiliag area ........ � g• � o•°°�
�,� e �'� '�, �,
4.......e...e ..............................................................TOTAL ��, �'�
If �otel of°�4 $e the es�e ae, or lesa than �2� you have met the intent of �_
Sn� 60Q6 �C) 1. �
AL1'ERNATE BUILDING ENVELOPE DESING
To tatili�e the tot�l envelope eystem method, the values establiahed bq the eum
Qg ;tem� f� �nd �4 eball not be greater than the eum of iteme �1 and �2.
y• �� C�� ��/'
3• _ �`"� , z �
,
+2. �.��
�____�.� _____
+4._ I�,��j
�
. % � , a�
m � .�
r �
1
sue�ecr PERM
City of Fridley 16 2 9 4
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � RECEIPT NO
� ; L ____ COMMUNITY DEVELOPMENT DIV. � � �^
r � � PROTECTIVE INSPECTION SEC. U
� _ �
`--_- A �����,'� CITY HALL FRIDLEY SS432 NUMBER REV DATE PAGE OF APPROVED BV
i �� 612-571-3450 910-F15
7 21-81 / /
JOB ADDRESS
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. � SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Keith E. McAmis 1650 Gardena Avenue 571-0876
3 CONTRACTOR MAILADDRESS ZIP PHONE �ICENSENO.
same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. �
8 USE OF BUILDING
above ground pool and deck
7 CLASS OF WORK
❑ NEW q, ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
A
8 DESCRIBE WORK
Construct a 15' x 27' above round ool and deck
8 CHANGE OF USE FROM TO
STIPULATIONS
See stipulations on letter dated July 7, 1981 from Environmental Officer
S��ERATE PERMlTS REQUlRE� �f:�R �i��a
N� A�f1edG. Pt.t1Mf31�tG AND S1G�.
w �.,���i-�'����
�� �
�. r�re d;gging sall locat utilitie��
TElEPH01� E- ELECTRIC - GAS Etca
����.������D �Y L�►�"�
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY 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 80 DAYS, OR IF CONSTRUCTION R_'1
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 CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 �� � � OO.00 �. 55
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $9.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECKFEE TOTALFEE
$2.25 $]].80
SIGNATUREOFCON7RACTORORAUTMORIZEDA ENr �DA7Ei PROPERLY A OATED THIS IS YOUR PERMIT
�d o 1 y�� �'�<� ° �7 +�.
'�- �� JtJ`"-l/� � �� % � � �i I�� "' ° �� i�.� �� � ���
'SIGN UREOFOWNERIIFOWNERBUILDERI IDATEI BLDG I SP nATE
3 r'
CITY OF F(tIDLCY • �
APPl.IC/17I0'd FOR Rl:SIUl:F1TI/lf_ QUILDI�IG PCRt�ITTS � .
(tdeti•r, All:er.�i;ions, Additions, or Repairs)
� OWtdER: _ t� r�- i T�-� � f ��-t�tl'�1 �
AODRESS: ���--� ��I�,���'�� �1`�
TEl RO : �] % —' � �' '�
�
13t1I LDER : - �%� %� � �,�,�� � `=
____
ADDRESS: • � ,
TEL FJO: ' �
� . Consi:ruction Location ' �
• 5TRI�T I�IO: �C� � STItEET: �-�-� ��� � �, �_ '
-L=i �
I� r.om: �� sr�ocic: AnnzTZOrr: �L� 1� 5�1��� � Z
! Corner Lot: ��E���
i
Inside Lot: �, SetbacY.: � Sideyards: , � -�'�
Ap�licant atta`ch to this form tt,ro Certificates of S�rvey of lot and
. proposed building location drawn on certi.ficates to scale.
� DESCRIPTIOid OF COt•aSTRUCTIOPd -
r��l�b (-�� L I'ront: L J� X��� D� th: 4
�, -�
P �. �� -� Height: �- �
��� r��- Squa�e. �'eet� Cxibic �'eet:
m _ ,�,� 7G c' �l� �
, �'ront : DeP� = H eight:
• Square• Feet: � Cubic I'eet:
TYPe of Construction: 1;1 {� y�,�T�'�i �t�� Est imated Cost: $��'�Q �G
3b $e Oor,�pleted: ��C�� �G(�'I . . . . .
� ,
� . - AZt. A Alt. 8
Prop�sed Drive�•ray Width If New Opening Is Desired: $�� $
. . .. SEE R^c.VERSE SIDE OF SHEET
. • � •
75ie undersigned hereb�� ma};e� applic�tion for a pernlit for the t:nrfi' herein specified,
agreeing to do ,all work in strict accordance �•�ith the City of I'ridley Orditiances znd
ruli�ig� of tlte Departntent of Buildinqs, and hereby declares thz� all the i'acts and
represent.-�tions stated :�l this applicatian �,re true and correct.
D.'�T�: ;�j� �1 I��� � SIGNATUF�:
StipullL-ions :
� v�����,
. C �'� �-� Q'�,
�- �.
�L/c� � �J��/ e � ° �, -
Q '� L'_ E �
� �2''°�-- �"Y"
4 - _� � _ ' .
p��,
P�� � � �
� �� '
n ,
�
,
�
���..
� � ��� �
1��+
� �
�� �
�
t
' • lSU11_1)11V1� 1'Llil'Il I I'L:L' :iCfll:l��11_l:' �p .
:;)::�''.Cx01•7 2. • 7.'1�� 7n�.:��cctor. of 13ui.lc?ii�cl.n ::li;►].]., },cto�:c i.,�,uituJ ��cnniC:; for lhc arr.ct•3.on
t,f• �i�iy 1�t�il.cl:ir��{ c�z :;i:ruct:urc, �r. fa�: �in�� ucicli.i:S��n to at�y �c�i��i�►� Lui�.Qincj o1 :�tntcLw:a,
. ci�' l:o�' a�,y ��l.i:r_r1L•iou or. r.cL�air.:.; L•o •any c::S. :t.ai»cl lnii;l.di.�r.J oz sL�:ucturc, u��c,n ar���li.cat.ion
�'th�l:�for.c, r.cqu.i.rc t:li� pa}�mc�►L 1�y tlic aZ�,��l.i.cai�t: �or. �;ucli ��cr.ma.L• of fecs ta LL'c �nvunt
hcr�a.n beJ.o�•1 sct• �or.tli ancl S.�i �hc �nanncr. hci:cin p�:ovicic:cl t�-�:�a.L•: .
tJ1:4�1 COI�S`P1:UC'�IOI�: Sing7.e 1'amil:y Iloine:s and Ga1-�zqes: ;4.00/J:,OJO ctxb5.c feat:. •
I?LAi� CII):Ct;: 25 i�er.cci�t: ot bui.lcling }�e�-miL- fee.
UItX��I:�•2A1' llL•'1'P.i:5SI0i•:: (CqncrcL•c, Ctiiri� �tzceLs Only) � �'
' A].tcrnat:e A: ltcmoval atid replaccment of• concre�e curb and
qui:ter 0111.,7; l�riveway �•�idth plus 6 fcet• x 513. �0
A].L•crnaL-e II: Removal. and replacement of concrete curb and
•� gutter and iiist�ll. a 3 foot wide approach ���ith ='
' ,• 6 i.nch depi:h; Driveway width �plus G feet x-$1S, 7� �
• � . �nni��onn� t��ror�►�1l1TI0(` � �
Por the purl�se of co�npui.ing iees foz building permits,. L-he cubica3. contents of any
�auild3,ng or additi.on, is dcL-er:nined by rnultiplying the qround area covered fro:n a
pua.nt six (6) inches below Lhe iloor ].ine oi i:he basemeni: or the ce�.lar to 't.iie
average heights of the •upper surface or to ihe average height of the roof. surf:ace
af 1.:iie raain gable of a pi.tched rooi. �,
Fox repai.rs or a].terations to an existang structure� the fee shall� be at the rate
of $3.00 �ier each five hundred do�lars�($500.Q0) �r fraction tliereQf in tiie cost
oi- all proposed wor.k. . , '
inT�no aase sha�.l the fee chargeci fc�z any pennit as'°se� iorth i.n Seetian 2 be less •
than $?.50 plus $.50 state surcharge. � . ' ' �
• � VERIFICATIO� OF FOUP�ID/1TIOfd .
NOTE: Permits �or consiruci:ion �aill be issued a minimiun oi 24 hours from t•l�e time
oi apnlication to a].low fox p�oper review of ihe proposed structure and oi ihe - .
construction site.
.� ' .
1l Certificate � of Survey of the lot, shoc,ring the loc�tion of tiie foundation once it
has been coz�s�ructed ���ill be required bef_are �roceeding with the i'raming.
�FRT I F� GATE QF ��GUPANCY � '
� j�PP�ication ior a Certificate oi Occupancy shall k�e made ten (lOj days prior to the
u�e ox OCCUfi311Cj� oi any st�-uc-ture for �ahich a builcl-i_ng permi� has been issued; and
said struci.ure shall iio� be used or occupied L:iiL-a.l a Certi.iicate of Occul�ancy has
been xssued. � �
�
�
. `
.
,
! �•
. �
. . . • • , .
. •
� .
- �
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432
,1
. McAmis
a Avenue Td. E.
5543 2
TELEPHONE ( 612)571-3450
Re: Swimming Pool Construction at 1640 Gardena Avenue N.E.
Dear Mr. McAmis:
This letter is to make clear this. department�s. requirements for the swin¢ning
pool construction at the above address.
l. As indicated, one (1) skimmer approved hy the National Sanitation
Foundation wi:ll be provided.
2. As indicated, one (1) inlet of approved design for fresh and/or
repurified water will be provided.
3. The filter and p�p shall be approved by the N.S.F. and be of
sufficient capacity to provide a mini:mum turnover of at least two (2)_
times in 24 hours. This department recommends a turnover rate of
6 - 8 hours.
4. A deck of at least three (3). feet wide, measured from the pool waters
edge, sha.11 be provided which extends completely around all private
residential pools. Above ground private residential pcwls may be
provided with decking of a minimlun size of 4 feet by 4 feet at pool
entxy points and provided that such decking has the approval of the City.
5. Fencing or other effective means including but not limited to walls
or buildings, acceptable to the City, shall be pronided to positively
control all access to publi:c and private residential swi�rani.ng �ols.
Fencing shall meet the following cri.teria: �
(a) The fencing shall prevent the entrance of children and he withnnt
hand or foot holds that would enable a person to climb..over i_t.
(�) The fencing shall be at least 6 feet high and entrances shall be
equipped with self-closing and self-latching gates capable of
being locked. '
(c) Self-clasing and self-latching devices shall be placed at the top
of the gate or otherwise inaccessible to �all children.
. (d) The opening between the bottom of the fence and the ground or
other surface shall be not mo re than four inches.
6. An auto�atic chlorinator should he provided with.a suitable�test kit.
7. All electrical and pl�nnbing installations shall be inspected and
approved by tlie City Inspection Depart�nent.
Mr. RQith E. McAmis
July 7 � 19!81
ge; gwimming Pool Construction
Page 2
S. All overhead electrical lines must be a minimwa of 10 feet horizontally
from the pool surface, and 18 feet stsaight line distance from the
waters edge. An alternative is to bury said lines. �
g. The pool fill spout must be protected by a vacuiun breaker or air-gapped.
10. Suitable safety equi�mment to include but not limited to a ring buoy
and rope that is 1� times the pool diameter, and shepherds crook pole
must be provided and mai.ntained with the pool at all ti.mes.
Furthermore, these and any other requirements must meet the provisions of
the Fridley City Code, Section 115, Swi�ning Pools. The buildi.ng peffiit i.s
approv ed contingent on f inal inspections and approval by the City.
If any questions or problems arise from this letter, please feel free to
contact me at 571-3450.
Sincerely,
.�
�
;J.�-_
,%i���
S J. O , R. S.
Environmental Officer
SJO/mh
�
�
�
�
�
:
m
0
�� i � -- 1
_ �
�,, �
;;
,� �
., !
�, �
;
I
�j
I
;
!
--� ----- -
- -i-._----
;,
,
i�
! '
���
i-
- ---- -- -r � - � _ . .
� _._. � a _ _ . . � . •--___.
;_.. ; .. � 1 :_
�, . , ,
� ; -
._.._. .. ... -T -- i --.. .1 . . . . _ . _.. _. . --
i, . , . , "` �""
, _� _ _�
i, , . .
-�-r-� _�.i _ _ . . �
'I `I , f
I�t�"- - I ' '-i " '��� �.�� �
j . � I . . , '
; ._ _ . � .: . --
; �- --_ __.
, �.-;-;-- -:- ;
.. - ,
��--r'. -, �+-=-----
F ,
----=-•- �_.___ � : �
I --+---:----- -�._� �._ �
�-.� ; �..�-�
� .� _�._�__... �_r_� �__ _ �
► `-�-�--� _:._ _y_,__�-_
<--_::��.�._ �_ � �_ �
�_. _ ; ___..__
F --� - 1-J.�.�-- __ ,
. , ' ��'..(' '�
_y__��.�--7__.�,:�-ti-_,. _�...
;
L.T_�_�.. � _� • S
I T._
�L -r�_T" . "� . _ �...J
�Y__� : . i
1 � --�
--� ;---� -�
-�-.'i�-1.�1 i
, ° ---_ t-T,_
_ .r1 J—i--.-�, _ _ .
� . � . , �
-+--�-'-•--i-- __—_.
1 � '„ . `-..-'.�.__'�
E! � j�`��.
4 ��� �`, ,
i � ��, ,\ .
�!;���.�
;� . ,��
� ���� ,� .., .
; I \\;.���.\: `''�.
� ! ` I "` `' `\� •
r, T ���
! , -�_��
� `
; ;j �'�,
, -��
i' j - - _' - _
�� { '__ __'
;i �
�;
� �--L------ - -- - -
� ,
�
�
;,
; ,
�, f I
i1 F.-_ i 1.�. ..... �_. .-_...�_ __" '
�
!
;: i
j
1I i �
: �. 1! _._ _ _ _.__- -
! �'_ j j- - - ---------
.' ' : j
�I I
�
i �
�� �
� 1 ' _��.'_" _..__. .
;! f
.I 1
I �
i �� -
�� i
�
1- -- -�- ---�--- ----_
9 F'
-i
/
- ��
�
i � Gf i-!'1'ECl.'
1;,P2��^C � � � .
�
�'�:.
T
i
----�\\ /; r
_ ..__ _-.��--'
�.
i l
�
� •
�
� I
30��FEA���' � � , , !
�,,�,, IS x27 x4 i
,.,C n,,�LJ� ABDUF GRGUU D �
' �_ pOC�L I
�
�
d�
� r
r
;► '' '`.�t
�� . r I '�� :
48 " np/5�� ; •
t�EC'K �: rTN ;I 1 � � (' '
3� .. � �,�� � + . � � _ ; i � ,
A�I�D �AlL ° � ' ; � t , i ; i j ' � �
�2ouuo I.i� 1, �:�� ; ;{ ,� ;;
PE'R�4M ETEI� � ; , � ; ' ' ; , � � I ! i ; 1 �
'=z- ----��i # i I i : � � ; ' j i : : i I
( � �i j )
�� � , 1' 1,
' � �;) � : �
4a�
7'1tE�
1�' -�
�
�
O
. �
.1 i�
, _
- i; ---- � -- - , 8� -
. �
NousE
I64o G'ARVEiup.
NJ
�F�G G�°S�I'�c,��,t�Nv.� ^
57�+iRS Eu['�.osED s� � E
[��/TN/�(► �'AX.'E' , m
oiQlZA�CTE2 _ -�I
# \J
tJl —�
t
1
� � .
" {
i
! .
�
i _ _
� � '-- c../�.
� �
i (
'
i _ �__ _ _ _
!
�f
�
---- ---.. `--- � --
(
n
i
� ' � �
. � j
SUBJECT PE ;- �
City of Fridley 3 3 4 3 2
AT TME TOP OF THE TWINS g � I L D I N G P E R M I T
r
; � RECEIPT NO.
� `L � COMMUNITY OEVELOPMENT OIV. ` ^ `�
r � � PROTECTIVE INSPECTION SEC. /� 7
i .1 �
L--_- = �����,.� CITY MALL FNIDLE� SS�3Z NUMBER AEV DATE PAGE Oi AVVqOVED BY
� l` 763-571-3450 910-F15 4/15/03 / /
JOB ADDRESS 1640 Gardena Avenue NE
1 LEGAL �OT NO. BIOCK TRACT OR AODITION SEE ATTACHED
oesca. Pt 36 Auditor`s Subdivision ��92 SNEET
2 PFOPERTY OWNER MAIL ADOqES$ ZIP PHONE
Keith McAmis 1640 Gardena Avenue NE 763-571-0896
3 CONTqACTOR MAIL AODRESS ZIP PMONE LICENSE NO
Walker Roofing Co 2274 Capp Rd, St Paul, MN 55114 651-251-0910 4229
e ARCNITECT Op OESIGNER MAIL ADDRESS ZIP PMONE IICENSE NO.
5 ENGINEER MAIL ADDFiESS 21P PFIONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION �] REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Tear-off and replace 25 squares of rubber roofing
9 CHANOE OF USE FROM TO
STIPULATIONS
Install per manufacturer�s specifications.
�e� �� ��������on ard�
���II �� ailed
�� �����,���r �°� P���
TYPEOfCONST. OCCUPANCYGROUP OCCUPANC�LOAD
SEPARATE PERMITS ARE REOUIRED FOR EIECTRICAL, PLUMBING, MEATING,
VENTILATING OF AIR CONDITIONING.
TMIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTqUCTION ZONING SC. FT CU fT
AUTMORIZEO IS NOT COMMENCED WITHIN 80 OAYS. Op IF CONSTRUCTION
OA WORK IS SUSPENDED OR ABANDONEO FOR A PERI00 OF 120 pqYS AT
ANY TIME AfTER WORK IS COMMENCED. NO DWLG. UNI7S OfFSTREET PARKING
I HEREBY CERTIFV 7MAT I MAVE REAO ANO EXAMINED THIS APPLICA710N 1 STA�LS GARAGES
AND KNOW TNE SAME TO BE TRUE AND CORRECT. A�L PROVISIONS OF LAWS yp�UATION SURTAX
ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED
WITH WNETHER SPECIFIEO MEREIN OR NOT. TME GRANTING OF A PERMIT �16,950 $8.�{.]
DOES NOT PqESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL TNE pEqMIT FEE SAC CMARGE
PROV�SIONS OF ANV OTNER STATE OR LOCAL LAW REGULATING CON• �279�25 Fire .SC, �16.95
STRUCTION OR THE PERfORMANCE OF CONSTRUCTION
PLAN CNECK FEE TOTAL FEE
ce se SC $5.00 $309.67
S�GNGTUAE OF CON'AACTOp OA oUTNOA�ZED AGEHT iD�rE� HEN PROPERLV VALIDATED TNIS IS Y R PER IT
R
S�GNOtUAEO�OWNEAi�FOWNEpBU0.DEN� �DAiE� G �NS� q6ft
NEW
ADDN
ALTER
[l
L]
L]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:' % � ��
/V� �ri D
Effective 1/1/98
N SS�3�
Legal Description: .
�
Owner Name & Address: %�� ` % %� c � � s Tel. # %�v 3 - S 7/ - o �'r �
Contractor: ��}-/�C'�i� t ��, �� �r � �t MN LICENSE# �z�%
Address: a a� y �',•p-� i�� �1`�° Cc.u, t�I �/ �-.s'ii y Tel. #��� - 2 S/ �- D�/ ra
�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height � Sq. Ft. _
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: �� � ° f� k �� c;/ —�- � S q k .S�ES — ��d� � `%- � 0�
�
Construction Type: �o a " ��- � � �^' Estimated Cost: $ % �� �1 �� ° � �
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft =� Ft x$ _$
�
DATE: �'� 7'���� APPLICANT:
Tel. #�,T/ � a�/ -a g i o
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ �7l. a.�
$ T%^ � S
$ �° � 7
$
$ J'��c�
$
$
��
$
$ ��94 �7
STIPULATIONS:
�,y o�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 df 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 [ ]
.. .