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PRE 2010 DOCSCity of Fridley, Man. 16 3 5 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT Date: —Augu" 31,1972 Owner. - An drew Wolf -- Builder Amber --C a s t wiA n k.3,an. oma, Address _ Address 6070 Stinson boulevard N.&. LOCATION OF BUILDING No. _ 599_5 Street ,,McKinley Street N.E. Part of Lot Lot13 —_ Block _ 1 __ _.___._.._...__ Addition or Sub -Division Amber Oaks Addition Corner Lot ___.._ _.____ Inside Lot _.._ X... Setback -35' — Sideyard is, & s t AA*Avl Elevation _-9.34..,,.9a. A'�iili4VQWIIevation 937.95._ Minimum y4zp- Top of Footing DESCRIPTION OF BUILDING To be Used as: Dwe 1 ing ____Y Front 32' _ Depth 40' Height 2&_1Sq. Ft. _10971 Cu. rt. _ fie _ Front 221 Depth 241 Height 10_ Sq. Ft. 151 Cu. Ft..61-501 Type of Construction Wood Frame Est. Cost _ 21 359 To be Completed Nov. 1972 Stipulatinns: Provide a hard surface driveway. Provide a verifying survey before capping. Call for rough grading inspection. WATER LOCATION: 14' S. of Sewer Service 47.7' SE of Manhole SEWER LOCATION: 14.4' N. of Manhole (Inv. 935.00) In consideration 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 in compliance with a'11 provision of ordinances of the city of Fridley. 1-17 10.68 State In consideration of the payment of a fee of $ 54.00 , permit is hereby granted to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all Work done in, around and upon said building, or any part thereof, shall conform in all respects -to the ordinamces of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings Within ordinantes. city limits and this permit may be revoked at any time upon violation o any of the provision of Said Building Inspector MM'MAAEL CLARK NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to as the Building Inspector for separate permits for these items. 0 ion .a APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT! t- CITY OF FRIDLEY, MINNESOTA OWNER' S NAME: �!✓� if -r-- az V l/n L , BUILDER: /7�/y1 E ,� � � - La ADDRESS: ADDRESS: Z 0 7o S r / /✓Sono i3 Lyl x/c D10 :•_ STREET • %e /�i,✓ S'�'� 11/ LOT; BLOCK: J ADDITION: Pool a k < 0�1�a CORNER LOT: INSIDE LOT: y SETBACK: 3 T SIMARD4 S � 4T � Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: A-¢�- � Front : Depth: ® Height: �<< J Square Feet: /fes Cubic Feet: Front: 2 2 Depth : 2 Y Height;_ y Square Feet, --776-- -..Cubic Feet: Type of Construction: �1-- Estimated Cost: $ To Be Completed: C� 7 The undersigned hereby makes application for a permit for tide _w6irk 'hereig specified, agreeing to do all work in sttict accordance with the city Qf Fridley Ordinances and rulings of the Department of Buildings, and heW07 declares that all the facts and representations stated in this appli9gt&9n are true and correct. DATE,: ? Z SIGNATURE: Ce , (See Reverse Side For Additional Information.)� IR .1 300 BRUNSWICK AVE. S. LOT SURVEYS COMPANY 69177 IDAHO AVE. N. -GOLDEN VALLEY, MINN. LAND SURVEYORS BROOKLYN PARK, MINN. MINN. REG. NO. 4741 MINN. REG. NO. 6743 xMisTsun vx=z Laws or BTATA or suxx=TA LiCBItUD BY OWMANOZ OP CITY OF MINNSAPOZM 3713 6747 W. Broadway 633.8922 INVOICE NO INDUSTRIAL. — JUDICIAL Minneapolis, Minnesota 66428 F.B. NO, 1 COMMERCIAL — TOPOGRAPHICAL ♦ �t �(� s CITY LOTS —PLATTING urbepOrs. catific ♦e SCALE 1" m AMBER CONSTRUCTION COMPANY o Denotes Iron Lot 13, Block 1, AMBER OAKS 1) hwN, � c r %N c1V 11yie+ hereby certify that this is a true and correct representation of a survey of the boundaries of the above described land and the location of all buildings and visible encroachments, if any, from or on said land. 15th Au =rust -� Surveyed by us this day of 19.72 4 GR��ar z1 r%Ywti LU Ll tie H �Q Signed LOT SURVEYS COMPANY • �c,0 for Power Plants and Heating, Cooling, VentikdonR RetEi"nWon and Air 0"Witioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .. $10.00 i Replacement of Furnace 6.00 i Repairs & Alterations—up to $500.00 6.00 Repairs & Alterations each add. $500.00 3.00 MECH. WARM AIR Furnace Shell & Duct Wort to 120,000 BTU ..... ..$10.00 each add. 60,000 BTU .................... 3.W = Replacement of Furnace 6.00 $ Repairs & Alterations—up to $500.00 6.00 $ Repairs & Alterations each add. $500.00 &W $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $_ Each add. 200 sq. ft. EDR Steam 3,nn $_ _ Each add. 320 sq. ft. EDR Hot Water 3,00 $— OIL BURNER—to 3 gal. per hour 6.00 $ _ over 3 gal. per hour --See Fee Schedule GAS BURNER (up to 199,000 BTU) .. .. . 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x$ 2.00 $ Additional Fixtures x .75 $ Gas Range to 199,000 z$ 5.00 $ AIR CONDiIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS k REPAIRS ROUGH FINAL �'•S� %� t Sae Fee Schedule i TOTAL FEE (SURCHARGE $_.50) Dept. of Bldgs,. Phone 860-3a City of Frldley: r The undersigned hereby makes application for a permit for the work hereir specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Owner Kind of Building Used as . __--.--..- To be completed about Estimated Cost, Permit No. � 16'07-7 Permit No. '5710 0 to ZIESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, We= Air—No Trade Name— — —y 7, Size N 10, Capacity_ �—Sq. Ft. E.D.R � �1 TU H.P Total Connected Load �,� �� Kind of Fuel- BURNER — Trade Name Size No Capacity Sq. F!. E.D.R BTQ B1P. (REMARKS -OVER) Siert U; rvrvg AGS Pfl1lpll"10"'Wli! a4lx Uil I ER DRIVEtet€���f� 5543ZBs i is v � r Ejg VMiDj Business Phone No 53-84-s-915.51 x 1 PARTIAL RATE SCHEDULE Pt.UMBING Fd1 MATES: NM SATE TOVAL Numhef Fixtures ................ x$100 3 fttum pbx4urz Opening .... o ...... x $1.50 IS®.. Now Fixture Old Opening ....... x $LAO $ Catch Basin ................. e . ® x $395 i Water Heater (Up to 95.000 BTU).... x $3.00 i New Ground Run Old Bldg. ........ x $33.25 : El bic Water Vaster .............. x $2..00 a GAS PIYTING FEES: NO. RATE TOTAL lot ............... x $100 $ J..3,Fiixttures fM/YiWalea'Fixtums .. . . . . ..... a ... _ $ .7$ $ 1 5.00 ass Raoge to 1".000 BTU . . A......... x $S.ib a • State Surcharge $� MWAM ! ALTMATIONS —Adu be N.060 _ 5.50 DnarivUOn ....................... , .. 0.0...... 0 .0....* TOTAL F= $ Kind of Building Frame Used as Res. -- To be completed about Estimated Costa $ 10.00 309=New. Building Porrnit No. Pa a llak Signed - By .. ,. , EC ASCO Business Pty No 53-84-5-915.51 City of Fridley Afpjid Gm RM" Pem* D -b5A. Of EldrL Phone NO -3m 7-TZCM!?"rS'V4 G7 'MORE C4 'A it Install Grill PARTIAL RATE SCHEDULE Va64VES- 906 RATE 'M�41 Numbef T1,2!�ves o � o ... — � ....... — x iloo V r'lj�ur,- rj'oz^,=T ':Penins .. - , � - o - , - a .— r 81-50 5 -- New Fixture 01c Opening .......... . X $1A9 $— CWN BaOn ....... x$3.216 $— rfitEr Heg4er 'uv to go. = 3W1. New Ground Run Old Bldg. ........ x 83.25 S Electrk Water Heater .............. _a mo 8— GAS rrMNG FEES. NO. RATE TOTAL lot 3 Fixtures ................ Is $100 Amsonal rutures .............. e—z$.75 • On Raisge to 199.WC STU x $5.00 State Surcharge MPAMS ALTERATIONIS-41der ft CC& 5.00 .......... 144tall, TOTAL FM 6 5.50 -5-urcnar —$22 N, E, Me Kinlen Street - city Cte. Andrew Wolf Kind of Building Frame U"d M Res. To be completed abqiut Estimated Coss, ]CM—New. Duilding P, -Tait HIM.. boor—, business �Cao� IV® City of Fridley Appkafl a for Pkmbbg and G= R"kq t Dept. of Bldgs Phone 560-345D DESCRIPTION OF WORE Plumber. Kind and Locaflon of ]!auras Location ire • r ��, i � � PLUMBING FIXTURE RYES. NO. TOTAL Number Fixtu es ............ a ... eRAAyTE -. x $2.®0 $ �v � Future Fixture Opening .... i ...... x $1.50 $ New Fixture Olaf Opening .......... x $1.50 : Catch Basin .................... x $3.25 $ � Water heater (Up to 99.000 BTU) .... x $3.00 New Ground Run Old Bldg..... ®... x $3.25 S Electric Water Restea.............. : $200 S GAS FITTING FEES. NO. RATE TOTAL lot 3 Fixtures ............ • • • • • -L_ x $100 $ Additional 11739tures ................-2$.75 : Gas Range to 199.000 BTU ............ x $5.00 $ State Surcharge $ .50 REPAIRS A ALTERATIONS —Aefar is CW _ Description O ... . .. . . . ...I .. ........ . ...... . 4.... ..... TOTAL TEE City of Fridley: The undersigned hereby makes application for a permit for the work here!, specified, agreeing to do all work in strict accordance with the City Ordinance and reeling of the Department of Buildings6 and hereby declares that all the fact and representations stated in this application are true and correct Fridley. Minn l9._ user 410:9=Z-4 Vind of Building ���•� - Used as To be completed about Estimated Cost. $ Old—New. Building Permit No. Permit No. 5`20 C ROUGH FINAL 3 --V- i,� Signed Business Phune SUBJECT P City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT 1` �, 21 91 i RECEfPT NO. COMMUNITY DEVELOPMENT DIV. ~ PROTECTIVE INSPECTION SEC. y VY o® o/ r NUMBER REV. DATE PAGE OF APPR VED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/12/92 JOB ADDRESS 5995 McKinley Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 1 SHEET Amber Oaks Addition 2 PROPERTY OWNT MAIL ADDRESS ZIP PHONE Rolt Dah.le 5995 McKinley Street NE 574-0952 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Joseph R Miller Construction 17900 Vergus Ave, Jordan EXX%B 55352 440-6625 5170 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 171 x 121 Attached Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan WAR' Before digging call for - all utility; locations 454-0002 SEPARATE PERNtITS R Utl ED FOR REQUIRED BY LAW WIRING 17NG, PLLWBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION. SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,628 $.81 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SACCHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $39.00 Fire SC $1.63 STRU ON OR THE PERFO MANCE OF NSTRUCTION. PLAN CHECK FEE TOTAL FEE License SC $5.00 $46.44 IGI ATUR OF CONTRA TOR R UTHORIZ AGENT ID EI W EN PRO LY VA DAT THIS IS YOUR P'ERRMMIT LDG INSP GATE SIGNATURE OF OWNER OF OWNER BUILDER) (DATE) NEW [ l ADDN [ ] ALTER [ ] Construction Address: Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application -P15- 1A(,�t,qt-r-7 5,1 /K E; Owner Name & Address: Contractor: Address: Effective 3/l/92 Tel. # 2 MN LICENSE # tua ✓� 6� ars M!� ��Tel. # 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 GARAGE AREA: Length Width_ Height r� DECK AREA: Length Width Hgt/Gr� OTHER: Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ 07 41 DATE: 2 APPLICANT:OAU Tel. #� CITY USE ONLY Permit .Fee,JFee Schedule on Reverse Side Fire Surcharge $ 1+ t3 •001 of Permit Valuation (1/10th%) State Surcharge $_ $.50/$1,000 Valuation SAC Charge $ $700 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ — Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ TOTAL STIPULATIONS: Agreement Necessary [ ] Not Necessary [ ] I L 5_1'7"'-'7'0k-2_ CITY CSF FRIDLEY INSPECTION DIV. Effective On January 1, 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES State Surcharge $ .50 Burner Trade Name BTU TOTAL FEE $3o�O MINIMUM FEE FOR ANY HEATING/COOLI�ENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. HEATI Approved ME Rough -In Date Size No. _10 Tel No. 9;z0-'Zq FILL OUT BACK SIDE FPR STACK VERIFICATION ON REPLACEMENT FURNACE cam. JOB ADDRESS 5QS' Rp _ RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in. strict accordance with the City Codes and Furnace Shell and Duct Work, Burner - rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 30.00 $�t representations stated in this application are true and correct. (Side Vent - Fill Out Back) j /C 199'? Gas Piping (Needed with new furnace) $ 10.00 $ OWNER r1t 4C12 Gas Range $ 10.00 $ BUILDING USED AS Gas Dryer *Air $ 10.00 $ ESTIMATED COST Ag 0<--> PERMIT NO. T Conditioning - All Sizes $ 25.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water)arm Air Trade Name �? Size No. Commercial/Industrial BTU 93 n I LTcx HP EDR 1.25% of Value of Appliance or Work $ _ Fuel_NaJTotal Connected Load State Surcharge $ .50 Burner Trade Name BTU TOTAL FEE $3o�O MINIMUM FEE FOR ANY HEATING/COOLI�ENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. HEATI Approved ME Rough -In Date Size No. _10 Tel No. 9;z0-'Zq FILL OUT BACK SIDE FPR STACK VERIFICATION ON REPLACEMENT FURNACE cam. CEWANEY AND STACK VERIFICATION The undersigned hereby verifies that the .existing chimney or stack: 1. Has been carefully examined Yes () No ( ) 2. Is free from rust or deterioration Yes () No ( ) 3. Has no foreign objects lodged within Yes ( ) No ( ) 4. Is securely supported Yes ( ) No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes () No ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes ( ) No ( ) 8. Has combustion air been provided for water heater Yes ( ) No ( ) Remarks:. List ALTERATIONS Being Done: HEATING CO: Signed By: Date: Job Name HEAT LOSS +70 F INSIDE - 70 F OUTSIDE 79 0 �–F—TE �W. DIFF SQ FT. I COEFF. p BTUH 9 �0- r9 00ea :47 Lumm — 1 HEAT GAIN 1 1 +75 F INSIDE 12" +95 F OUTSIDE 9„2 L20_F TEMP. DIFF 991 SQ JT. I COEFF. 11 BTUH, NORTH 25 E/W 75 SOUTH 1 40 3" Lumm — 1 1 1 1 12" 3 9„2 991 4 6" 3 6 91 Y' 4 3" Im 3" 3" 19 3 4 1 7 10 1-1/2 NO. 600 blw ade5 ------ 10 0 walkoutut 10 OOC SUBTOTAL UBTOTAL ATTIC/ CRAWL SPACE 25% I ATTiC /CRAWL SPACE 15% I Vol IBM m, 80% FURNACE divide by.70 = 90% FURNACE divide by .80 = 7A.C1 FURNACE SIZE AIR rn"moNER SIZE FURNACE FURNACE MODEL # AIR COND. MODEL # NOTE ONOW OF HOUSE ON BACK OF TO FIN 2500 m i SUBJECT O. City of Fridley Q. 33174 AT THE TOP OF THE TWINS BUILDING PERMIT r R _ _ COMMUNITY DEVELOPMENT DIV.�� 1 PROTECTIVE INSPECTION SEC. 1 NUMBER REV GATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55132 ' 763-571-3450 910-F15 10/16/02 JOB ADDRESS 5995 McKinley Street NE I LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 1 1 Amber Oaks Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Rolf Dahle 5995 McKinley Street NE 763-574-0952 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Dan Netko Exteriors 1305 104 Lane NE Blaine MN 55434 763-784-0227 20060494 / ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION O ALTERATION O REPAIR X O MOVE O REMOVE 8 DESCRIBE WORK Reroof House & Garage (25 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 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 $2,894 $1.45 WITH WHETHER SPECIFIED HEREIN OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE ���,�7 �® f-�� Licens C $5. $92.59 GNATURE OF CON'RACTOR OR AUTHORIZED AGENT IDATEI EWPRLY VALID ED THIS IS OUR RMIT B G -NSP' E SIGNATURE OF OWNER,IF OWNER BUILDERI IDATEI i NEW I ] Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572.3604 Bldg Insp ALTER SINGLE FAMILY AND DUPLEXES R4 AND R-2 BUILDING PERMIT APPLICATION Construction Address: 5-995- / r )C 1e n kms, ET V% J Legal Description: Owner Name & Address: f?vJ ,4) bei l de- Tel. #76 3 - S7 y- b 915-a Contractor: 7)Gtr A )eA4 LL�� MN L I C E N S E #- a0D6DVfe{ Address: /3b5 - /D4k L(�, ivC B% &A) YjL ll Tel. #763-7eV-P:P-a-7 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: r-:;� -5 Construction Type: Lw- I J�- Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $, DATE: APPLICANT: JaWjnDV-J,- Tel. # 7i3 -7W Qua? CITY USE ONLY= Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ 93, Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ Z, $.50/$1,000 Valuation SAC Charge $ $1150 per SAC Unit License Surcharge $ �Q-f) $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: