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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT x® 4363 Date: J..L..-_-7. - 1-0?...-1.._..........�.f....... -................... ........ 44 Owner: - ....... ................................ Builder _�-! ft-..... ._.... Address--------•-----------•----------•---• .............. _................ Address ....................... - �/ _ LOCATIO�N�OFF BUILDING .._......//�.,........ Part of Lot - ......................---------- 1 • Logo --a.... .° .:....... Block .................. Addition or Sub -Division ... .......... _........... ............................ `..`' o� Corner Lot ........... ............... Inside Lot ...X ...... ............. ....... Setback .. ..............7........ Sideyard....... ......... ...... ........... Sewer Elevation ................................... _......... .... _............. _......... ............................. Foundation Elevation .............................................. DESCRIPTION OF BUILDING Used as: s "� .................... Front --e� Depth 3��® Height.. .. Sq. Ft. •7f Cu. Ft. 10 J►� .... ..............-...................................... Front -- ................ Depth ....... .......... Height .........�_.. Sq. Ft................._...... Cu. Ft. ...................... Type of Construction ........................... .............. ........ _........ Est. Cost.'./..q......... .. To be Completed ..... _............. _.............. ................. 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 ^fp con lance with ai� provi on�oP ordinances of the city of Fridley. �� %'+'°�✓N� %�� In consideration of the payment of a fee of $_OF._I ................, permit is hereby granted to ........ ...._....................... 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 ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. -' Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. 4 City of Fridley, Mian.. N° 8654 BUILDING PERMIT LOCATIO OVBUI ING �, No. Street ��� � 2 6 Part of Lot Lot _ Block Addition or Sub -Division t ° e g Corner Lot _ Inside Lot Setback .„. Sideyard Sewer IIevation Foundation Mevation DESCRIPTION OF BUILDING To be Used�as " Depth , Ll Height Sq. Ft. Cu. Ftp-/� Fro t Depth - �� Height Sq. Ft. Ca Ft. Type of Construction AM f �To be Completed In consideration of the issuance to me of a permit to conatru b ding described 'free I to do the proposed work in accordance with the description above set orth in compliant ons oP ordinances of the city of Fridley. In consideration of the payment of a fee of . V is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that the pion to whom it is granted and his agents, employees and workmen, in aII work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota ardin� location, conatructton, alteration, maintenance, repair and moving of buildings within the dty limitan3and tb�s permit may be revoked at any t]e upggp von of any of the provisions of said ordinances. NOTICE: M pw* don not door the conatradtion, hwai d1w for wWne, pWmbino, 0a has&& ewer or water. Be son to ae the BWWIna icor for apm to perm(ts for thea Henn. a APPLICATION FOR BUILDING PEPIMT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME ADDRESS ADDRESS LOCATION OF BUILDING No. ,���� Street Pa t ofot Lot Block Addition or Subdivision Corner Lot V' Inside Lot Setback10 Side Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. DESCRIPTION OF BUILDING To be used s: Front�,� Dapth �,j�®2 Height -Q Sq. Ft. Cu. Ft. Type of Construction To be Completed .Front Depth Height Sq. Ft. Cu. Ft. Estimated Cost 5 The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE_ � SIGNATURE Schedule of Fee Costs can be found on the Reverse Side). City of Fridley J AWteafiion for Plumbing and Gas Fitting Permit' Dept of Bldgs. Phone SII 4-7476 DESCRIPTION OF WORE Location �� � S Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL_ Number Fixtures ...................... �P/ x $1.50 Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ....... .................... x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... / x $1.50 $�a� C1 Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $ City of Fridley: The undersigned hereby makes application for a permit for the work herein 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. Fridley Alinn Z 19-111? r Q Owner / 19— Kind of Building Used as To be completed about Estimated Cost, $ O u Old ew. uilding Permit C By l ( / Business Phone 11 POST 1M-12-58 19— cc F Y Z C z z O w G ? z • ® WATER HTR. 3U S o 8c y t�3 �� �O P N GAS ELEG m Base 6 1st 2nd 3rd 4th • Future Connection Openings Connected with New Fixture, Old Openings I Sewer Cesspool 0 PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL_ Number Fixtures ...................... �P/ x $1.50 Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ....... .................... x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... / x $1.50 $�a� C1 Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $ City of Fridley: The undersigned hereby makes application for a permit for the work herein 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. Fridley Alinn Z 19-111? r Q Owner / 19— Kind of Building Used as To be completed about Estimated Cost, $ O u Old ew. uilding Permit C By l ( / Business Phone 11 POST 1M-12-58 19— - i.ds�A..■ L 6431 UNIVERSITY AVENUE N.E.. FRIDLEY, MINNESOTA 55432 May 16, 1980 May ( 612)571-3450 Mr. Robert Spong S & S Investment Co. 1202 Pike Lake Drive New Brighton, MN 55112 Re: Repair & Maintenance of the Rental Property Located at 5475 14ain Street N.E., Fridley, MN (FINAL NOTICE) Dear Mr. Spong: Enclosed please find this department's letters dated December 6, 1970 and January 15, 1980 that brought to your attention various Housing maintenance violations in the apartment building located at 5475 Main Street N.E. A subsequent reinspection on May 14, 1980 has determined that the following items continue to be in violation of the City Residential Maintenance Code and sre still in need of corrective action: EXTERIOR 1. Provide and maintain a screened enclosure to conceal the refuse container from view. In addition, a hard surface base should be provided for easier handling by the hauler. 1�-/ -2- // -7,7 2. Provide and maintain striping for the parking lot to designate individual parking stalls (10' x 201). /Va Therefore, the City must require you to correct the above listed items on or before June 9, 1980 when a reinspection will again be conducted to determine compliance. We are confident in your cooperation and desire to correct these violations and if any questions or problems arise, please contact me at 571-3450. Failure to abate these violations may result in this matter being turned over to the City Prosecutor for his legal consideration. Sincerely, STE EN SO , R. S. Environmen Officer SJO/mh ENC: 2 CC: Ms. Georgianne Kruize 5495 Main Street N.E., Apt. #5 Y 2 =L Y 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 TELEPHONE ( 612)571-3450 ° rJanuary 15, 1980 a F. R Mr. RDbert Spong ' S & S Investment Co. 1202 Pike Lake Drive New Brighton, 14N 55112 A' Re: Repair & Maintenance of the Rental Property Located at 5475 Main Street N.E., Fridley, Minnesota (SECOND NONCE) Dear Mr. Spong: Enclosed please find this departments letter dated December 6, 1979 that brought to your attention various housing maintenance violations in the apartment building located at 5475 Main Street N.E. A subsequent reinspection on January 14, 1980 has determined that the following items continue to be in violation of the City Residential. Maintenance Code: EXTERIOR 1. Provide and maintain a screened enclosure to conceal the refuse container from v.*.ew. In addition, a hard surface base should be provided for easier handling by the hauler. 5--1,4-5 A4." 2. Provide and maintain striping for the parking lot to designate individual parking stalls (101 x 20`). y-- 6Y P AAD *3. It was observed that the tenants were parking on the grass. If the parking provided is insufficient, then additional hard surface parking should be provided. Questions can be directed to the City Planning Department. LAUNDRY ROOM This inspection also noted that th4 last inspection for the fire extinguishers was in October of 1977. The fire extinguishers must have current inspection dates. Questions can be directed to the City Fire Department. 7._-.27 Therefore, tie City must require you to correct the above listed item on or before February 11, 1980. Due to the incli.mate weather, the items marked with as asterisk may take until May 5, 1580 to be completed. Reinspections will again be conducted on the above dates to determine compliance. We are confident in your cooperation and desire to correct these violations and if any questions or problems arise, please contact me at 571-3450. Failure to abate these violations may result in this matter being turned over to the City Prosecutor for his legal consideration. Sincerely, h STEVEN J. OLSON, R.S. Environmental Officer. ENC: 1 f. 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 5.6432 TELEPHONE ( 612)571-3450 ti A December 6, 1979 �, r� e' E ,�,:, Mr. Robert Spong S & S Investment Co. 1202 Pike Lake Drive ya° New Brighton, MN 55112 Re: Repair & Maintenance'of the Rental Property Located at 5475 Main Street N.E., Fridley, Minnesota Dear Mr. Spong: It was confirmed by a routine on-site inspection on December 6, 1979 that the above listed rental property was being maintained in violation of Chapter 220, Residential Maintenance Code, of the Fridley City Code. Although the general condition of the property was good, the inspection on the above date found the following list of deficiencies which must be corrected. Any repairs or improvements must be completed in a workmanship like manner. It is the City's hope that'similar or other deficiencies in apartments that were not inspected will be corrected as needed. EXTERIOR 1. Provide and maintain a screened enclosure to conceal the refuse container from view. In addition, a hard surface base should be provided for easier handling by the hauler. `../y M 2. Provide and maintain striping for the parking lot to designate ® individual parking stalls (10' x 20'). 3. It was observed that the tenants were parking on the grass. If ® the parking provided is insufficient, then additional hard surface parking should be provided. Questions on this can be directed to the City Planning Department.l�-/�1 �a LAUNDRY ROOM This inspection also noted that the last inspection for the.fire extinguishers was in October of 1977. The fire extinguishers must have current inspection dates. Any questions on this can be directed to the Fridley Fire Department. �La /4 �$ — Z FURNACE ROOM o`F 002,.k, No orders this date. APARTMIN T # 5 No orders this date. APARTMrNT #8 0 No orders this date. Mr. Robert Spong 14 S & S Investment Co. December 6, 1979 Re: Repair &'14aintenance, 5475 Main Street N.E. Page 2 A reinspection will be conducted on or about January 7, 1980 to determine compliance. We are confident in your cooperation on these matters and if any questions or problems arise, please contact me at 571-3450, ext. 164. Failure to abate these violations may result in this matter being turned over to the City Prosecutor for his legal consideration. Sincerely, STEVEN J. OL ON, /L2. S . Environmenta fficer SJO/mh CC: Ms. Georgianne Kruize 5495 Main Street N.E., Apt. #5 ,i s G L --,gip �,-'�_�- �•'P''' ,�� �� 0 [737- ;�-��� SG�s bL-9'7d .Sb 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 65432 Mr. Robert Spong S & S Investment Co. 1201 Pike Lake Drive New Brighton, MN 55112 TELEPHONE ( 612)571-3450 Re: Renewal of the Multiple Dwelling License for September 1, 1980 to August 31, 1981 for 5475 Main Street N.E. Dear Mr. Spong: Enclosed please find the City's renewal form for a multiple dwelling license to operate rental dwelling units at the above listed address. This form must be (1) completed (2) dated and signed, and (3) returned with the appropriate license fee to: City of Fridley Attn: Mrs. Evelyn -Loomis 6431 University Avenue N.E. Fridley, MN 55432 THIS MUST BE ACCOMPLISHED NO LATER THAN SEPTEMBER 1, 1980. Applications and fees received after that date will be.assessed a late fee in accordance with the following schedule; 1 to -7 days late - 25% of the total due; 7 to 14 days late - 50% of the total due. It has also been determined through on-site inspections on December 6, 1979, January 14, 1980, February 27, 1980, May 14, 1980, and June 12, 1980 that the following items continue to be in violation of Chapter 220, Residential Maintenance Code of the Fridley City Code. 1. Provide and maintain a screene& enclosure to conceal the refuse container.from view. In addition, a hard surface base should be provided for easier handling by the hauler. 2. Provide and maintain striping for the parking lot to designate individual parking stalls (10' x 201). The need to correct these items was brought to your attention in letters dated DecEmber 6, 1979, January 15, 1980 and May 16, 1980. IF Mr. Robert Spong S & S Investment Co. July 21, 1980 Re: 5475 Main Street N.E. Page 2 At this time the City staff can not recommend approval of your license. A reinspection will be conducted on or about September 8,.1980 to determine compliance with the above listed items. If it is found that items continue to be in violation, then your license application will be reviewed by the City Council at its public hearing meeting on September 15, 1980 at 7:30 P.M. Your attendance is recommended. If any questions or - problems arise from this letter, please feel free to contact me at 57I,-3450. Sincerely, STEVE J. OLSON, R.S. Environmental Officer SJO/mh ENC: 1 N CITY OF FRIDLEY 6431 UNIVERSITY AVENUE N.E.. FRIDLEY, MINNESOTA 55432 TELEPHONE ( 6.12)571-3450 December 18, 1980 74 Mr. Robert Spong✓�- �� l S & S Investment Co. 1202 Pike Lake Drive New Brighton, MN 55112 Re:'�City Council Approval of the 1980-1981 Licenses for the Residential Rental Properties Located at,5475 and 5495 Main Street N.E., Fridley, MN Dear Mr. Spong: At its regularly scheduled meeting of December. 15, 1980.the Fridley City Council considered the approval of the licenses for the above listed properties. Council approval was tabled pending correction of the following deficiencies, Provide and maintain a screened enclosure to conceal the refuse containers from view at each above noted address. Due to inclimate weather, the City is aware that the above deficiencies can not be corrected until the summer of 1981. Therefore, if a.written request is received no later than January 12, 1981, an extension until June 1, 1981 will be granted and the licenses will be submitted to the City Council for approval. If no written request is received, and the deficiencies have not been corrected, the City will seek compliance through legal action. If I ca.n.be of any assistance in this matter, please call me at 571-3450. Sincerely, ./ STEVEN J.• LSON, R.S. Environmental Officer SJO/mh A, C.., �a 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 r ¢ r TELEPHONE (612y571-3450 u " December 18, 1980 • Mr. Robert -Spong S & S Investment Co. 1202 Pike Lake Drive New Brighton, MN 55112 Re: City Council Approval of the 1980-1981 Licenses for the Residential Rental Properties. Located at 5475 and 5495 Main Street N.E., Fridley, MN Dear Mr. Spong: At its regularly scheduled meeting of December 15, 1980 the Fridley City Council considered the approval of the licenses for the above listed properties. Council approval was tabled pending correction of the following deficiencies; Provide and maintain a screened enclosure to conceal the refuse containers from view at each above noted address. Due to inclimate weather, the City is aware that the above deficiencies can not be corrected until the summer of 1981. Therefore, if a written request is received no later than January 12, 1981, an extension until June 1, 1981 will be granted and the licenses will be submitted to the City Council for approval. If no written request is received, and the deficiencies have not been corrected, the City will seek compliance through legal action. If I can be of any assistance in this matter, please call me at 571-3450. Sincerely, 0 STEVEN 6. OLSON, R.S. Environmental Officer SJO/mh July 6, 1981 Robert Spong 1202 Pike Lake Drive New Brighton, MN 55112 Re: Exterior Site Improvements for the Residential Rental Property Located at 5475 Main Street Northeast. Dear Mr. Spong: On at least three occasions in the past, the City has brought to your attention the need for some minimal exterior site improvements for the apartment building located at the above address. A reinspection has determined that the following item continues to need corrective action: Provide and maintain a screening enclosure around the refuse container. It is recommended that the container be placed on a hardsurface base for easier handling by the hauler. Also, the screening oon- struction should be substantial enough to resist damage and large enough to provide for easy access and snow removal. At this time, the City must require that the above listed item be corrected or improved and that you provide us with a proposed plan and time table for completing this work. Please return your response and license application no later than August 10, 1981 to the attention of the Code Enforcement Department. Your positive response to this needed improvement will assist us in evaluating your application to renew the license for the 1981-82 licensing period. We are confident in your cooperation and if any questions or problems arise, please contact me at 571-3450. Sincerely, Steven J. Olson, R.S. Environmental Officer SJO sar Enc: License Renewal Application CITY OF FRIDLEY APPLICATION FOR PWMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ a,Ol $ Future Fixtures mid 3.50 u Old Opening, New Fixture k 0 $ Water $ 4.00 $ Slow Off Basin $ 5.00 H a (d1e $ 5.00 m w p, 5.00 Hydraulic Valve Heater +i d Sump or Receiving Tank $ C, FOCI Water Treating Appliance ai al pM .pC 21 $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 10 of Value of Fixture or 9 ow° O O State Surcharge S .50 Reinspection Fee $ lec tSi1 U a m 3i vii w iia�3 c3 c� Fit Rana- 1st 2nd 3rd 4th (R) m Future Connection Opening Connected with Sewer (*) - New Fixture, Old Opening Water S RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser $ 4.00 $ Slow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 10 of Value of Fixture or Appliance $ State Surcharge S .50 Reinspection Fee $ ($15.00) TOTAL FEE S //6 Effective Aug. 1, 1981 Job Address � 111 � l') OL I J V 5 t, , Department of Buildings. City of Fridley Tel. 6571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct 1- � Fridley, J , 19 " OWNER 1 V , RIND OF BUILDIING -( Yarm -t p USED AS fl 1" -ta 1) V rVX) J %V TO BE COMPLETED ABOUT �q ESTIMATED COST l 1 U 3 V V OLD - NEW BUILDING PERMIT NO. PERMIT NO. /( CompanY C/0 Signed By T.I. No. ROUGH INSP. Date FINAL INSP. .3 d 2 2 - Date APPROVAL FOR PERMIT /Y=/` MINIHUM FEE FOR ANY PLUMBING PERMIT" $10.00 PLUS THE $.50 STATE SURCHARGE^ SUBJECT P City of Fridley 30835 AT THE TOP OF THE TWINS BUILDING PERMIT r COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. ,,�A06 1 � � 1 = --'"1 CITY HALL FRIDLEY 55432 NUMBEROATE TREV PAGE OF AOPROVEO BY 612-571-3450 910-F15 4/17/00 / / 10B ADDRESS 5475 Main Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt. 9 5 1 Carlson's Summit Manor North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Scott Clover 2575 N Fairview Ave #250, Roseville, MN 55113 (651) 638-0860 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO GLJ Enterprises 3704 N Milton St, Shoreview, MN 55126 (651) 484-7565 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING 12 Unit Apartment 7 CLASS OF WORK O NEW O ADDITION O ALTERATION REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Replace all windows except bathrooms 9 CHANGEOFUSEFROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 12 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $16,400 $8.20 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE R LOCA LAW REGULATING CON• Fire SC $16.40 R CTION OR E PERFORMA OF ONS UCTION 279.25 PLAN CHECK FEE TOT L FEE 303.85 'T0 r _S ATU OFCO .ROAOR/AUOAIZEDAGENT E PROP VALID T HIS IS YO PERMIT 01 G NSF' /ATE S.GNATURE OF OWNER�,F OWNER SWILO 1 iDATEj Prepaid Plan Check $ Effective 1/1/2000 Estimated Cost $ CITY OF FRIDLEY (612) 572-3604 Receipt # R-3, COMMERCIAL & INDUSTRIAL / BUILDING PERMIT APPLICATION �� V Construction Address �'yp s Zoning / '' EE Legal �.��.� N, i�av �� ��5� Owner & Address �C % /o V �i S �� Tel# (/_L) Ll �s CONTRACTOR & ADDRESS 0 0 MV -C A..✓ (,t���+ ��, �➢ 5'yC Tel# -�/f Architect Reg.# Engineer Reg.# BUILDING CONSTRUCTION TYPE OF WORK [] New [] Addition Alteration -Describe OFC. AREA: Length Width Height Sq. Ft. WHSE AREA: Length Width Height Sq. Ft. OTHER AREA: Length Width Height Sq. Ft. APPLICANT , Tel # Date P VALUATION Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) _ $ /� (Q{ Ito Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) TOTAL VALUE Building Use Construction Type Occupancy Group Air Conditioning [] Yes [] No Fire Protection Provided [] Yes [] No Performance Bond Amount $ See Reverse for Schedule Received []Yes Permit Fee $ C.2 29, o?S Plan Check /6 , 4/6 Fire Surcharg� _� 0 State Surcharge' $ SAC Charge $ Erosion Control $ Park Fee $ Spec. Assessments $ Driveway Escrow $ TOTAL $ [ ] No PERMIT FEES See Fee Schedule on Reverse Side In Excess of Prepaid Amount - See Reverse Side .001 x Permit Valuation (1/10th *) $.50/$1,000 Valuation (See Sched. for > $1 Million) $1100 per SAC Unit (Plans to MWCC for determination) $450.00 Conservation Plan Review Fee Determined By Engineering Agreement Necessary [] Not Necessary [] feet x $15.50/foot ATTACH STIPULATIONS