AF - 47435i9
City of Fridley, M�n,. � 1 � 3
, 6431 University Ave. N. E., Minneapolis, Minn. 55432
BUII.DING PERMIT
��: _ °'�.t� �9��
p�r; ,�Philllp_Hanson �..._ Bu;ider Tri-Co Builders
Address _.__.__..__.__..._._.__....__.. �_.___..._._�_._�_� Address 7561 Van Buren Street N.E.
LOCATION OF BUILDING
No. _._._..__� 45 �.._ Street .Y._Jacks on S t ree t N. E, p� o! Lot
Lot ._.._.2__.__._�_.... Block _...........1..__.__.._...._._.._ .............. Addition or Sub-Division _Melody Ma.noT 3rd Addition
Corner Lot ..._._......._.-•---•-- Inside Lot _.._..._?�.�._._____ Setback 30 � �. Sideyard 14 �
Sewer IIevation
Foundation IIevation _._.._._
DESCRIPTION OF BUILDING
To be v�a �:
Dwell.ing ..--------..--- Front 26 �. Depth �'� � Height _.__�...... Sq. Ft. 1056 �, �, 20„__�____800..
�a�_._..___._.._.._.._ Front ..28 �_ Depth � Hei�ht lU r Sq. F� _.�g! Cu. �`t. _.�}g�}1
Type of Construction ___.ErAmP _..._._ Fst, Cost ..._.�2QT.052...._.....�._ To be Completed Jan. 1� 1972
STIPULATIONS: ]���¢ Provide a hard surface dirve and verifying survey before capping
basement.
SEWER: 27' South of Ma.nhole just North of Concerto on Jac kson Centerline
WATER: 17' South of sacne manhole as sewer.
Wye 879.67
Top of Footing (Minimum) 882.67
In consideration of the issuance to me of a permit to construct the building described above I agree tq �
the proposed work in accordance with the description above ,Sgt forth and�c:o�plia�oe � a'll praviaions ot
pl+dinances of the city of FridleY• /�! � /
Ea c�sideration of the payment of a fee of � 50.00 , permit is hereby granted to ��i-Co Sg,ilders
_�_..... ._..._.__.._ ............._.._.__ to construct the building or addition as described above. This permit is granted upo�t
the express condition that the person to whom it is granted and his agents, employees and wori�nen, in all Wa�k
done in, around and upon said building, or any part thereof, shall conform in all respects •to the or8ia�nc� Od`
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and oving of buildiIIgs
,yrithin the city ]imits and this permit may be revoked a t any time upon violatioa oE any of �e provit�ionA ot said
ox�dfaances.
_ CLARENCE BELISI.E ^
�
NOTICE:
Zhis psrmit do�s not eover th� eonsfruetion, instailation for wiring, piumbing, gas h�aliwg, �w�r or wahr. 6� s� fo p�
1h� Building Insp�dor for separats permih for th�:� fNms.
u:-
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APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADllITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
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��Yl\riA�� ��lL7�i DViL�Gili .„•jLL.�''� �� �-'V - lr�r���t"�"V" ' ✓..
tlLLi��7 S : �11JL1���7 S :
NO:. %�� f STREET
LOT: o� BLOCK:
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CORNER LOT: INSIDE LOT:
;�.,
• . � �,�0
ADDITION • r'' r ,-..r ._;<<, .�
�_S ETBACK : O � S I DEYARD : � `� �
Appli�ant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
�,
BESCRIPTION OF BUILDING
n
TO Be Used As: �'T�'%'�''� /�.�' "'��'L{"��' / i
�,,. V
T_; � ���,.�' Front . � t� �i Depth : � G� Height •
�
Square Feet: �Q ��� Cubic Feet: o?G, ��a
� � Front ; a $' Depth : a� � Height : � �r G�C
Square Feet; ,�i Cubic Feet:_ �,/ G'
Type of Constructioa: �%�rs►�,r��• r Estimated Cost: $� 0, O��
To Be Completed: `^' �` � ";� � '
The underaigned hereby makes applicativn for a permit for the work herein
specified, agreeing to do all work in sttict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildiags, and hereby
declares that all the facts and representationa stated in this application
are true and correct.
DiATE : � ' S IGNATURE : �e�'� �C� �
(See Reverae Side For Additional Information.)
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any existing
building or structure, or for any alteration or repairs to any existing
building or structure, upon application therefore, require the payment by the
applicant for such perniit of fees to the amount herein below set forth and in
the manner herein pravided to-wit:
tJDTIFORM BUILDING CODE: �pe 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average�
height of the roof surface of the ma.in gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be
lesa than $5.00. ,
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a mini�m of 24 hours from the
time of application, to allow for proper review of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
haa been constructed, will be required before proceedin_e with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building penuit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued. -
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3i;i�;t, X�i
sue�ecT PERMIT NO.
City of Fridley � 034
AT THE TOP OF THE TWINS g U� L D I N G P E R M I T •
� � RECE
� �
� i y______ COMMUNITY DEVELOPMENT DIV. �
r � PROTECTIVE INSPfCTION SEC. �/'_��) ��
� �. i (0 `-�CJ
l-_•- A /"�1'� CITY HAII FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPFlOVED BV
L � � � � g12-580-3450
910-F15 _75 � /
108 ADDRESS
7451 J�ICKS�N STREET N.E. FRIDLEY M T
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 1 MEI,pDY MANOR 3RD ADDITI SHEET
2 PROPERTY OWNER MAIL ADDRESS � ZIP PHONE
Ci�RYL 7
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
4 AHCHITECT OH DESIGNER MAIL ADORESS 21P PHONE LICENSE NO.
5 ENGINEER MAIL ADORESS ZIP PHONE UCENSE NO.
6 USE OF BUILDING
7 CLASS OF WORK
O NEW ❑ ADDITION � ALTERATION O REPAIR ❑ MOVE � REMOVE _
8 DESCRIBEWORK
9 CHANGE OF USE FROM TO
STIPULATIONS
YI�A�I��' : �� ,�� G,
Before di�H � � �� . �,��R�
t�pNE-EIE:C'�iG.c+� Etc. ��� P�G �p g1t'.a��•
REQUiRED 8Y �w �" S� A.�NG. P�v��E�
�4E
SEPARATE PERMITS ARE REOUIRED FOH EIECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAO
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTflUCT10N 20NING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHtN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WOHK 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 COMPUED.
WITH WMETHER SPECIFIED HEREIN OR NOT. THE CaRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pE MIT FEE SAC CHA GE
PROVISIONS OF ANY OTHEF; STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �
PLAN CHECK FEE TOTAL FEE
�SIGNATU OF ONTRACTORORAUTHORI2EDAGENT IDATEI �11/ N P P LY AL AT THIS IS YOUR PERMIT
/
SIGNATU E OF OWNE Ilf WNE BU D 1 1 ATEI BLDG tNSP nATE
_ _ _' _ ._ rr• s r.:�
.
�APpLICATION FOR R�:SIDL'NTIAL., ALTEItATION,
OR AllllITION.BUILDING P�R�1IT
CITY OF FRIDLEY, I�iINNESOTA
OWNER'S N[1I�1E: ? �//oSE.�._. BUILDER:. Qrd,t�
ADDRES S: i� f/ cT 1�Ca rr/ �/t/. C, ADDRES S;
NO •. % ��,,,� _ �
STREET • c.� �So v� CFT JV -
LOT :_�_ BLOCK : J ADDITION : - � ����
CORNER LOT : INS IDE LOT : SETBACK : SIDI;i'Ar.D :
Applicant attacr �o Chis fo±�n 7.tao Certificates of Survev . of Lot. and .propose '
building location drawn on these Certificates.
BESCRIPTION OF BUILDING
o Be Used As : .
+ �
Fxont: Depth: � Height:
�� �� /J Square Feet: Cubic.Feet:
� �
.
Front: Depth: �ieight:
Square Feet; Cubic Feet•
�pe of �Construction: �,�ry1� Estimated Cost:_ $ i� .
To Be Completed: �.�� ,�
/
The under.signed hereby makes applicatinn fox a permit for the work herein
specified, a;reeing to do all worlc in stiict accordance with the City of
Fridlcy Ordinances and xulings of the ll�partment of Buildings, and hereby
declares tl�at all the facts and representations stated in this application
are true and correct.
• • UATE: � SIGNAT[TRE •
(See I�e exse Side For Additional Information.)� •
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City of Fridley 214 2 5
' , AT THE TOP OP THE TWINS g � I L D I N G P E R M I T RECEIPT .
r
� �
� ; y __��_ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. �..
1 . r
� � /'�'1 � CITY HAIL FHIOLEr 55132 NUMBER tiEV. OATE PAGE OP APGROVED 8�
�"'"� � �'' 612-571-3450 9t0-F15 6/29/92 � �
108 ADDRESS 7451 Jackson Street NE
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 1 Melody Manor 3rd Addn SHEET
2 PROPERTV OWNER MAIL ADDRESS ZIP PHONE
Alfred Rejman 7451 Jackson Street NE 783-9173
3 CONTHACTOR MAII ADDRESS ZIP 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 BUIIDING
Res identi.al
7 CLASS OF WORK
�7 NEW � ADDITION ❑ ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Construct a 25' x 14� Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See notati,pns on plan.
��R��`;��i
Before diq�lnB c3i4 for
all utility tocations
454•0002
REQu���D �Y �w.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY IOAD
SEPARATE PERMITS ARE HEOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIF CONDITIONING.
THIS PERMIT BECOMES NULI ANO VOID IF WORK OR CONSTRUCTION ZpNING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTHEET PARKING
I HEHEBY CERTIFY TNAT 1 HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
ANO OF;DINANCES GOVERNING THIS TYPE OF WORK Wlll BE COMPUED $1� 7S% �S. HS
WITH WHETHER SPECIFIE� HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pEqMIT FEE SAC CHAHGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $4]. �OO Fire SC $1. %C�
STRUCTION OR TNE PERFORMANCE Of CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
$43.64
SIGNATURE OF CONTRACTOF OR AUTNORIZED AGENT IOATEi HEN P OP lY VA I�A,T TNIS IS VOUR PERMIT
i ' 6 6�z�
SiGNA RE OF OWNE ��F NER BUILDERI ' IDATEi �DG SP nA7E
x�w [ l
ADDN [ ]
ALTER[]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: 7 % `J I
Effective 3/1J92
Legal Description: J� EL� �NVn 31�� � J�� 1..C�2 C�1.c�� K/
Owner Name & Address: ���'D ��Zi�'.y-iY_�_�f.7/ l:'1'El. �� S�3 9�/%.3
Contractor: MN LICENSE #
Ac�dress: Tel. �
Attach to this applicari�, a Certificate of Survey of the
lot, with the proposed consh�ion drawn on it to scale.
LIVING AREA:
GARAGE ARSA:
DBCK AREA:
OTHEI�:
DFSCRIPTION OF IIIRPROVEMENT
Length Width Height
Ix,ngth Width Height
I.e,ngth �_ R�idth j y� HgdGround �
Sq. Ft.
Sq. Ft.
Sq. Ft. p `'
Corner Lot [ J Inside Lot [X� Ft. Yd Setback �_ Side Yard Setbacks 7�
Type of Const�uction: ��c�� Estimated Cost: � 1����
Approx. Completion Date: q�,Q - 9'�
(Cost on Back)
Driveway Curb Cut Width Neecied: Ft. + 6 Ft = Ft x$ _$ �' �
v T--
DATE: -- APPLICANT: � F!'�� ��'�� Tel. #� X.� c1f7�
��-
Permit Fee ��� c � Q Fee Schedule on Reverse Side
Fire Surcharge $ % r%�o .001 of Permit Valuation (1/lOth96)
State Surcharge $ t $.50/$1,000 Valuation
SAC Charge $ —� 5700 per SAC Unit
License Surcharge $ $S.OU (State Licensed Residential Conha.ctors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Park Fee $ -�- Fee De.termined by Engineering
Sewer Main Charge $� Agreement Ne�essary (] Not Necessary []
TOTAL
STIPULATIONS:
�
�. �
S
BUILDING PERMTf FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure,
or for any addition to any existing building or struchrce, or for any alteration or repair to any existing
buildiag or shuch�re, upon application tb�efore, require the payment by the applicant for such pemut
of fees to the amount herein below s� forth and ia the manner herein provided to-wit:
TOTAL VALUE
�1 to SS00
�501 to 52,000
52,001 . to $25,000
$25,001 to $50,000
�50,001 to $100,000
�100,Of� to 5500,000
5500,001 to $1,000,000
$1,000,{l01 and up
FEFS
$15 (Minimum Fee is $15 plus surcharge)
$15 for first 5500 pins SZ for each a�ditional �100 or
fraction thereof, to and including 52,000
S45 far first 52,000 plus $9 for each aaditional 51,000
or fraction thereof, to and including 525,000
5252 for f�tist �2.5,000 plus �6.50 for each additional �1,000
or fractian thereof, to and including 550,000
5414.50 for first $50,000 plus 54.50 for eac6 additional
$1,000 or fractiiion th�eof, to and including $100,000
5639.50 for first 5100,000 plus $3.50 for each additional
$1,000 or fraction thereof,,,to and including SS00,000
52039.50 for the first 5500,000 plus S3 for e�ch a�ditional
�1,000 or fraction thereof, to and including 51,000,000
53539.50 #oF the ��st $�,000,000 plus �2 for e,ach a�ditional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Conc�ete C�rb Streexs Only)
Alternate "A" : Removal and replac.ement 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 FOUNDATION
Permits for con�hvction will be issued a minimum of 24 hours from the time of application to allow
for proper review of the proposed structure and of the consbiuction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been
constcucted will be required before procceding with the framing.
,
Pt� !JP C�?NST. VJASTcS OAILY
$'(0!2� 1N i�:�V AP�£OVED PAANNER
��� E A!1 RcFUSE j�EK�Y
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8329 CENTRAL AVENUE ■ MINNEAPOLIS, MN 55432
TELEPHONE 784.-3062° '`
— Complete Line of Building�Materials —
TO '
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JOB dESCRIPTtON AND ADDRES$
ACCOUNT NO. F.O.B. ESTIMATE NO. DATE �
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ERRORS AND OMISSIQNS ARE SUBJE.CT TO CORRECTION. ��
/
TERMS: 30 days net. 1��� %:
1.5% interest per month (18% annual) will be charged on all past due accounts. � j
Prices are good for 10 days only. Delivery within 30 days. / �� '�U
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SPRING LAKE PARK LUMBER CO.
8329 CENTRAL AVENUE ■ MINNEAPOUS, MN 55432
cA�� - - TELEPHqNE 784-3062
784•3062 �. � .
— Complete Line of Building Materials —
TO � � JOB DESCRIPTION AND ADDRESS
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nish ONLY WHAT APPEARS ON THIS ESTIMATE except as an ADDITIONAL CHARGE�
ERRORS AND OMISSIONS ARE SUBJECT TO CORRECTION.
TE R MS: 30 days net,
1.5% interest per month (18% annual► will be charged on all past due accounts. �
Prices are good for 10 days only. Delivery within 30 days.
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; �M�V �ui �r�Lq� u��wwt��f A�v� YNw �}rc� tN fMi ��rMa• e/ �sfe`f7�leiy Irf �• �t ►w�rr
u
•�e►.' Oqr1d �kis �_,r,�,,,�}' �{ f�`A. C. 1�7�.
SUSUR�AN lNBiNlERINO, INC.
�.�.��, ��,�"�� ��� ..
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SUBJECT P , J
City of Fridley � � �c�2
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � RE�TNO.
� • COMMUNITY DEVELOPMENT DIV. �
� Ly �'���
r � � PROTECTIVE INSPECTION SEC.
i
' , ��'�1 � CITV HALL FRIDLE� SS03Z NUMBEF REV OATE GAGE UF AVPROVED B�
�'""'�"� �'� 612-571-3450 910-F15 11 / 15 / 94 / /
JOB ADDRESS 7451 Jackson Street NE
1 LEGAL LOT NO. BLOCK TRACT OFi AODITION SEE ATTACHED
DESCF. 2 1 Melody Manor 3rd Addition s►+eer
2 PROPERTV OWNER MAIL ADDRESS ZIP PHONE
Alfred Rejman 7451 Jackson Street NE 783-4173
3 CON7RACTOR MAIL ADDRESS ZIP PHONE UCENSE NO
Same
4 ARCMITECT OR DESIGNER MAII. ADDRESS ZIP PHONE IICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIFi O MOVE O REMOVE
X
8 DESCRIBE WORK
Reroof House *25 Sq (Tear-off)
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCV�OAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTHICAL, PLUMBING, HEATING,
VENTILATING OF AIR CONDITIONING.
THIS PERMIT BECOMES NUL� AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTpUCT10N
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANV TIME AFTEFi WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALIS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1 875 .91}
OOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW FIEGULATING CON-
STRUCTION OFi TME PERFOFMANCE OF CONSTRUCTION �F3.00 Fire SC 1.8H
,�� � PLAN CNECKFEE TOTALFEE
_ i���'a'',CG� ,f��G7�1 �/— /J- �L/ 4
SiG ATU�7EOFCON�RACT� RORAUTMOAIZEDAGENT IDATE� WHEN PHOPE VALIDATED THIS IS YOUR PERMIT
- � �
I
S�GNATUAEOFOWNEA�IFOWNERBU��DE�71 iDATE� B G iNS� OiT
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
/
ca�eoaAaa��: %G`.S / �- /�
Effective 1/i/94
Legal Descripdon: �
Owner Name & Address: �, ��F �,�,i� L�, j�/.S? /�/ Tel. � 7 f��,�%/�
Contcactor: $�1.�/� . MN LICENSE #
Address: Tel. #
Attach to this appiication, a Certificate of Survey of the
lot, with the proposed constni�tion drawn on it to scale.
DESCRiPTiON OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE A,REA: Length Width Height Sq. Ft.
DECK AREA: Length Width HgtlGround Sq. Ft.
, .
OTHER: tl� D�! N�.. ���u rr� s
� � s �_
Corner Lot [] Inside Lot [] Ft. Yd S�c Side Yard Se�acks ,
Type of Constivcdon: Esbimated Cost: $
Approx. Complexion Dat�e:
(Cost on Back j ; � . '` � .`
Driveway G�u�b C}ut Width Nceded: Ft. + 6 Ft = Ft x$ =$
�
DATE: j I-% 5—��� APPLICANT: ��L'��.� E, %f�l` Tel. # 7�l3 9�/��
Permit Fee .
Fire Surcharge
State Succbarge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Controt
Parlc Fee
Sewe.r Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY _. ,,,
,
_ ., .
S�, � Fce Sc�d�ile on R�veise Side
$ .001 of Pexmit Valuation (1/lOth%)
$ , % `' 5.50/51,000 Valuadon
$ 5800 per SAC Unit
$ �5.00 (Sta�e Lic�nsed Reside,ntial Contractors)
$ Alt. "A" or Ah. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Det�mined by Engineering
$ Agreem�t Necesssiry [ ) Not Ne��essa�' ( ]
$ ��.�„s,� �
-� :
.-
I3UiLDING PERMiT FEE SCHEDULE
`i�he Chief [3uilding Ofticial shail, t�efoce issuing permits for the eroction of any buitding or s6r�ucture,
or for any addition t� any cxisting huilding or stnucture, or for any atteration or repair to any existing
building or struciure, upon appiication therefcxe, r�equire �e payment by the applicant for such permit
of fccs to the amount hercin below sct forth and in the maruier herein pcovidod to-wit_ ``
"t'OTAL VALUL
� 1 to $500
$SOi to $2,000
$2,001 to $25,000
$25;001 to $50,OOU
� �50,001 to $100,000
$100,001 to $500,000
FCES
$IS (Minimum Fee is $15 plus surcharge)
$15 for fust $Spp pjus �Z for each additiocial $100 or
frac6on thereaf, to and including $2,000 �
-$45 for first $2,ppp pius $g for each additionat $1;000
• or fraction theteof, to and includng $25,ppp •
� $252 for first� $2S,ppp pl�s $6.50 far each additional $1;000
� or fradion thereof, to. and including $50,000 .
$414�0 for fust �50,000 plus �450 for each additional
$1,000 or fra�ctioa tl�eof, to and including $100,000 :
�G3930 for -.�irst -�100,000�'p1us� x3 S0� `for each"'addiaonal - '
$1,000� or':ir.�ioa t�o�- to._and_ includ�ng::.$S�pp,Upp ° � - ���'
_ .___. _ , . a�:., .
: �uu,t)O1 �o �i,000,000- -::_ - $2039.SO�:�for����t �'S00;400 plas}��ii'for :ea
� .. ;
_ . . �. �� .
$1,000 or fr�ion th�eof, to and including $1
$I,000,001 and u _ ,
P __ �353950. for- t�e 5rst gl . � , . .
Alternate "A":
1111�aW �l]�'
,ppp,000 plus $2 for each additionai
$1,OU0 or fraction t.hereof .
� r� .. "r��=� �_�- -� ,
DRiVEWAY : DEPRESSION�: ESCROW : .,` -� � -. :.
- i�a�'ete C���Streets ':pnty) . �� .... . X `�e � �, ��t .
Removal and r la � �.��+�.x:b . _ .� � .�:5 = =�.v �
eP oem�t of.* aub :�� �y 'Dnveway wid� plus 6+feet times �A,
$13_SO_ : �� ,� _:. x _ _ �. ��`t��.j,:� �,.,�.��
Removal and. replacement `of curli" i�ndq�gut�e,r�. ac�d install a 3'foo�wide. '`'�' �"�����°``'`°
u
approach with 6 inch depth -:Driveway; width pius 6 feet times S 15_75. ', ,� ��..�� ..
VERIFICATION OF FOUNDAT[ON
Permits for constiuction wi11 be issued a minimum of 24 houcs from the time of application to allow
for proper review of the proposcxl stnucture and of the construction site_
A Certificate of Sunrey of the tot, showiag the location of the fouaclation once it t�ac it has been
constructcxl will be rcx�uirect before proceeding w�th the frdming_
�-.._ .a.
�
SUBJECT
City of Fridley � � ? � 4
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
f
� �
� �• COMMUNITY OEVEIOPMENT DIV. EC
' j 1i -
r � � PROTECTIVE INSPECTION SEC. J J73
� . �
' � �'��1 � CITY HALL FRIDLE� SS4$Z NUMBER pEV DATE PAGE UF APPROVED BY
�""� � �'' 612-571-3450 910-F15 4/4/95 / /
JOB AODRESS 7451 Jackson Street NE
1 LEGAL �OT NO. BLOCK TRACT OR ADDITtON SEE ATTACHED
DESCR. 2 1 Melod Manor 3rd Addition SHEET
2 PROPERTY OWNEfi MAIL ADORESS 2�P PHONE
Alfred Rejman 7451 Jackson Street NE 783-9173
3 CONTRACTOR MAILADORESS ZIP PHONE UCENSENO
Standard Water Control S stems Inc 5337 Lakeland Ave
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
537-4849
5 ENGINEER MAIL ADDHESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ A�DITION f� ALTERATION O REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOFiK
Install interior draintile (sump pump) system
9 CHANGE OF USE FROM TO
STIPULATIONS
Drain field must meet or exceed the City Engineering Department's
recommendation.
TVPE OFCONST. OCCUPANCY GROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PIUMBING, HEATING,
VENTILATING OR Alq CONDITIONING.
THIS PERMI7 BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SO. f7. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 DAYS AT
ANY TIME AFTER WOqK 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 ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �isSOO �p.7S
DOES PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pEqMITfEE jnV. Fee SACCHARGE
PROVI I NS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
TRU T N OR THE PE RMAN E OF CON RUCTION. �3.5.0� �35.00 Fire SC �1.5�
( PLAN CHECK FEE TOTAL FEE
\.: - �� � Q' License SC $5.00 $77.25
NATUAEOFCQN'RACTORORAUTNOAIZEDAGENT �D TEi WNEN PFiOPERL VALIDATED THIS IS YOUR PERMtT
- � � .�
� SiGNATUAE OF OWNEA UF OWNEA BURDEAI iOATEi BL �N57 �� E
NEW
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 1 / 1 /95
�( «3
Construction Address: 7�,5 � J Ac ��;,�� ��a ��
Legal Description: � %' �� � � �� �%7 f%�►f� L1 � ���' � �/L-� 4�
Owner Name & Address: �QL��t.� fif�',�nAn� �►4P.���� Tel. #�3— 917 3
Contractor: ��.p (�.�AT�- e-�'��.. �`iSi "�.s l�c_ MN LICENSE # eeo t�z�.
Address: �33� l�a%.��� �✓� ��YSzx+� 55�i9 Tel. # 53'T —'`/gS�`l
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length Width Height
�ng�h Width Height
Length W idth Hgt/Ground �
—� - - — �.. _ _ , � rv� �$:,,.,
e
Sq. Ft. _
Sq. Ft.
Sq. Ft.
Corner Lot [] Iaside Lot [ j Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimated Cost: $ �� �%`��'
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: .+ 6 Ft = t x$ =$
DATE: �
� APPLICANT: . � Tel. # 537' S�Fyi _
�Nv. ���_
Pennit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park F�
Sewer Main Charge
TOTAL
,� S , ��'�
$ .�� , c?a
$ 1, S�
$ , �S_
$
$ S� Uo
$
$
$
$
��S`
$
-- _ � , .
Fee Schedule on Reverse Side
.001 of Permit Valuation (1 / lOth %)
$.50/$1,000 Valuation
$850 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 ( ]
STIPULATIONS: ..
<-_ -
«uii.i��rvc; ��c�t��-r rcc sc����tn_r
�I'he Chi�( f3uilding Ulticial shall, (x;forc issaing permits for thc ercxtion of any huilciing c�r struclure,
��r ti�r any a�iciiticm tu any cxisting building or struclurc, or for any altcration or rcpair to any cxisiin�;
(�vililing or su'ucturc, upUn a�plication thcrcfore, rcquire the �ayment by d�c ap�►licant for such �crmit
��I� Icc;.t tc> thc; a�nount hcrcin f�cl<�w sct li�rth and in thc n�nncr Ix:reia �rc►vidui to-wit:
'1'O"1'nL VAI,UE
� 1 io $S00
�501 to �2,400
�2,001 to �25,000
F�I:S
$!S (Minimum Fcc is S15 plus surchatge)
$15 for first $500 ptus S2 for each additional Si00 or
fraction thereof, to and including $2,000
$45 for fiist $2,000 plus $9 for each additiouai $1;000
or fraction dier�of, to �d including $25,000 �
�25;001 to 550,000 - $252 for first� $25,000 p(us $6.50 for each additional $1;000
� or firaction thereof, to. and including $50,000
�50,001 to 5100,000
�100,001 to �SOO,Q00
$SOO,OOi to $1,000,000
$i,000,001 and up
$414_50 for first $50,000 plus $4_SO for each additional
$1,000 or fractitoa thereof, to and including $100,000
$639.50 for €ust �$100,OOU plus �$3_SO for each additional �
$i,000 or fradion �f, to and including �$500,000
$2039.50 for the fust SSS00,000 plas $3 for each additional
$1,000 or fraction th�e�f, to and including $1,000,000
�3539.50 for the first 51,000,000 plus $2 for each additional
$1,000 or firaction theroof -
DRIVEWAY DEPRESSION ESCROW
(Concrete C�irb Sbreets Only)
Alternate "A": Removai and replacement of cutfi aad gut�er o�ily - Driveway width plus 6 feet times
� 13.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3%ot �vide
approach with 6 inch depth - Driveway width plus 6 Eeet times �15_75_
VL•RIF[CA"CION Or FOUNDAT[OIY
['ermits for cor�st�uction will be issued a minimum of 24 hours from the time of application to allow
Cor �ro�cr rcvic;w of thc �roposul stnacturc and of thc ca�struction site.
A CerUtic::ite of Survcy of tlic lol, stiowing the location of tiic foundation oncc it h�e it has hccn
co��structc:�i �vill hc rc;yuirc;cJ tx:ti�rc proceccliab with lhc fraa�ing_
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CHIlVINEY AND STtQ►CK VERIFICATiON
The undersigned hereby verifies that the e�cisting chimney or stack:
.1. Has been carefiilly examined Yes (�) No i)
2.
�3.
4.
5.
6
Is free &om n�st or deterioration
Has no foreign objects lodged within
Is securely supported
Meets all curnent Code requirements for size
and total BTU's connectsd
Has total heating BTU's of
All other BTU's
Y'es()No()
YesONoO
YesONo{)
Yes ( ) No ( )
�
TOTAL BTU's
7. Has a liner been pmvided for water heater Yes � No ()
8. Has combustion air been provided for water heater Yes () No �
Remarks: . � � L✓ /' `t� f=� `�
G
List ALTER.ATIONS Be'wg Done:
HEATING CO:
Signed By:
Date:
��-/L -9 s� . -
sue�ecr � PER�,,�
City of Fridley `f2 7 5 01
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T �
� i 'f�GElPTN�O.
� ; y ___._ COMMUNITY DEVEIOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. .�% ��
� . � �J�/
�
� � /"'1 � CITY HALL FRIDLE� SS4$2 NUMBER REV DAlE PAGE OF APPNOVED BY
�----� • •,' 612-571-3450 910-F15 9/1/98 � �
10B ADDRESS �i
Jackson Street NE
t LEGAL LOT NO. BIOCK TRACT OR ADDITION SEE ATTACMED
DESCR. 2 1 Melody Manor 3rd Addition SNEET
2 PROPERTY OWNEH MAII AODRESS IIP PFIONE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Stock Roofin INc. 289 Libert St NE Fridle 1
e ARCHITECT OR DESIGNER MAII ADDRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PMONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRI9E WORK
Reroof house and ara e 22 S Tear-off
9 CHANGEOPUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIREO FOF ELECTRICAL. PLUMBING, HEATING, TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NUIL ANO VOIO IF WORK OR CONSTRUCTION 20NING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAVS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO fOR A PERIOD OF 120 OAVS AT
ANY TIME AfTER WORK IS COMMENCED. NO. OWLCa. UNITS OFiSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION STALIS GARAGES
AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yq�UATION SURTAX
AND ORDiNANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIEO
WITH WHETHER SP E�"Ml1Rl�P�pR-IpQT-THE GRANTING OF A PERMIT
DOES NOT PR ME TO GIVE AUTHORITY TO VIOIATE OF CANCEL THE pERM1T FEE SAC CHARGE
PROV�SIONS ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR E PERfORMANCE OF CONSTRUCTION.
PLAN CNECK FEE TOTAL fEE
SIGNATUAEOFCON7RACTO�:OAAUTMOAIZEDAGENT IOATEI WFIEN PIiOPERLV. UDA ED TNIS IS�VOUR PERMiT �
' ��
SiGNnTUAE O% OWNEA i�� OWNEA BUiLDER� i0A7Ei Bl0 �NSP r�FTE
NEW - [ � Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �/� �
( BUILDING PERMIT APPLICATION � � �` � �,
�/ .-- �
ConstructionAddress: � 7 S� ./p cr�S�ti �
Legal Description:
Owner Name & Address: Tel. #
Contractor: S�6G� , cd�,� ��� � MN LICENSE #
Address: 2c,a � �• � �,� �i ��- Tel. #
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:
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width Height
Width Height
Width HgdGround
3 l��-
7l�4-.356/
Sq. Ft.
Sq. Ft.
Sq. Ft.
a a � �-
Construction Type: Estimated Cost: $ s
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: S, ( APPLICANT: G�� ,�� Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
� �
$ S�• S 0 Fee Schedule on Reverse Side
$ �,� 4 .001 of Permit Valuation (1/ lOth%)
$ . 9 � $.50/$1,000 Valuation
$ $1000 per SAC Unit
$ b� O� $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 [ ]
$ 6 �. 3 z
y
t -
BUII,DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building 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 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
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 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 $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(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 FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
�
Building
�ns�ect�ons
763-57��3604
17ATE_..��—�-_ �
3JT� AUDRC35 �
�I'HI5 APi'LICANT IS:
PRd�PUYRTY O'�VNER1
TENANT
GQNTRACTOR
SUBMI�' A COPY Or
'YOUR STATE LICFNS�
WITN t�►PYLICATIUN
PROP�RTY TYPE
• PEYtMIT T1fpE
T"YPE O�' WORK:
�ulLnne��
R�S�DErt'�'IAL A►PPLIC�TI�N
C.IT� OF FR�DLEi�''
Y(]UR E MAIL AUURISS _„�,,, ,
on Sf- �E _ , ...
O UWN6R CON'fltACfOR
VAl�: _ �. - �L. w�� .
AL7URESS� U ,� /V L
PH(7PIE: 3 � ,( � 3 ....
�van2E. ., y ��=aC�� O �S
3TA7'E LiCENSE a�S,�S (oS (o . ExP
Ap6kFS3: `��
.,....�.., /„ C 1�_ A r �Ie � r.esr
o �cwo FnMt�Y�r�w co�vs��cus: n�r
Q AI) iTION ❑ UARAG
Q BASF�t�1' FINLSH G RUpF
fI t�Ci{ _ _ _ f3 SIDlA1t'r —
DESCRI�E WaRK �L�ING
SIZE OF IMPROYEMBNT
R LJ I1V V �D Wva. r
NUMBER oF SQuARES „ � HOIJSE dc CiARACiE
GA1tA(:E5 C] A1"i'ACH6D GAKAGE
PftOP06ED 51%E:�� ❑ DETAC:HED GAItAGE
FROIaUSF� HEIGHT: _ ,
3lDING OsatfEt ' .
I] Vinyl , G'ftim
� Aluminuon ❑ F�cis
p Otha �,�
WIIV
IN 6� 7t1�G OPk�.NID9GS ec C1No LOCA7'1C�1 OF W i�'DOWS
OR FOR NSW 4PBNINC�-D63CRIBE S1ZG OF �� -
�NENING CHANG�L•S dt
TYPE OF WMDOW 'TO BE INSTA4LCD Nl1I�BR (� 11YR'1DOW5
�7 t1RAQ1 TII.E
C3 Q'l7�1FR
1. Exiscing I
1. PmPnaed
3. list of sb
FOR NEW CONSTI
ADDITIONS. dc I'Q
t. SitoPlary
and ptopi
2. 7"wo scts
3. I?,�rgy C
ALL �EES AR� BASLD ON VALUA'i'ION,1N'CLUDING TI�E COST OF I.A�OR AND
TOT.A�L JOB VALUATIO iurru��.� • x a L•
Pemiit Fen $ _ SS See Back Page for Fee Scheduie
�,�� R�� g 85�i6 of Build'eng Permit Fce
l�ire Surcharge S /%� .00� times the tot�l job valuation
Surcharge � .�O .�005 x Permit Valuation Niinimum �.50
�5.00 State Licensed Residential Cantractors)
I.,icc�a Surcharge $ J� Ov_ t
SAG Cherge S $1675 per SAC Unit (Plans to MWCC fc�r determi
Curb Cut Escruw S ft+ 6 ft a ft x� 1��
�rasion Cantrol S, S45U Conservatioe Yla� Review
Pork Fae $ Fee Determined by �ngineering
Sewar 1V1ein G'he�'ge $ _ Agreement nece�ssary {) Non Necassery ()
Total Uue , S S/ L.� S Make checks a able to: Ct of �'ridi
T[i1S (S AN At'Y1.1CAT![.laV FOR A P6KMiT-N�T VALiD UNTIL PROCESSEU
1 hereby apply f�t a building pertnit and I 8eknowledge tha�t 1tu� �nEarmati�n ai�ove is compXete and accu
conformance with the ordin�nces and codes of the City ��f l�ridley �+d with the Mim�esota Construction Cpde�
permiC btrt only an app�ication fvt' a petmit nnd woric is not to .ctart wlthou� a Penmit; that thc work will be in
plan in tlie case of a1l work which requirea review and appruvai of Pla�'s. �/nn /,
4E,.---���" "�,.LS V ��. �i
SiGNATUREUFAPPLECANT . _.. . . '
Na.;�
ed By:
1�
�
ATE�J L�7_,�,��� �
Ft.
Plan
r plan
ral manbeni lo be �aod
'110N [NCLUDING DF�,CKS,
IES 3IlBMl'L
rry showing tt►e existing slruc�res
PrRI�
Dnstrtwtion p�arn
latic►ns �
iu; that �he wak will be in
that 1 understand this is not e
�ccorclence with tho approved
Eu _9�e� _ ��,��dl
Td WdZ0:b0 Z00Z Z0 'inr LBZZZLS£9Z: 'ON Xd� haiPia� .to h���: W0�1�