PRE 2010 DOCS-4 -,?w f7
City of Fridley, Minn.
BUILDING PERMIT
Date: FEBRIIARY 25, 1966
Owner: Builder AL WILLIAMS
Address Address 8562 East River Blvd.
Minneapolis, Minnesota 55433
LOCATION OF BUILDING
No. 5765 Street MAIN STREET N.E. part of Lot
Lot _ Block
Addition or Sub -Division
Corner Lot _ Inside Lot Setback Sideyard
Sewer Elevation — Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
HOUSE Front 26 Depth _ 8 Height 20 Sq. Ft 9$$_ Cu. Ft. 19,760
Front Depth Height Sq. Ft. _____ Cu. Ft.
Type of Construction FRAME Est. Cost _ $15 , 000 To be Completed
LEGAL DESCRIPTION: The Southerly 27 feet of Lot 6, Block 25, Hyde park,
together with half the vacated alley lying adjacent
thereto, and that part of the vacated IM 572 AVENUE
lying northerly of Lots 1,2,3 and 4, Block 1, City
View Addition.
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 21 provisions of
ordinances oP the city of Fridley.
In consideration of the payment of a fee of $ 20.00 , permit is hereby granted to AL WILLMIS
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 buildAn-
wiorthinn the city limits and this permit may be revoked at any tune upon violation of any of the provisions of said
ALLEN G. JENSEN
NOTICE:
M pormb don not am tho aonatruatle, Mdaftftn for wbtng, plumbing, gn haft, aowar w waMr. Be an to as
the BolMh* Mapoator for apmto poemHa for thao ilea.
560-3450
City
o
�HidCe
ANOKA.
COUNTY
4-
6431 UNIVERSITY AVENUE NE
FRIDLEY, MINNESOTA 55421
June 283, 1973
Mt. Raymond Swenson
5615 Camden Ave. No.
Minneapolis, MN 55430
Dear Mr. Swenson:
X15
It has come to the attention of the Inspection Department of the
City of Fridlpy, that a pile of debris (cut imbs and o er
dehr!s)_ has accumulated u Lot 7, Block 2.5=
Hyde Park A ition.'Iri—s is in violation of Fridley Or finance,
Section Number 2(8) to wit: "Accumulation of tin cans or debris."
Hopefully, you will personally take care of this violation prior
to a reinspection in a week to ten days, and prior to an issuance
of a tag. I believe that a rubbish service will haul away these
trees if they are cut into small enough pieces.
If I can be of assistance or possibly clarify the Ordinance, please
contact me.
RLB/cm
cc: Darrel Clark, Community
Development Administrator
Peter J. Herlofsky
Administrative Assistant
Sincere ,
. L Barnette
Inspection Department
JAMES E.BETZ &Associates
ATTORNEYS AND COUNSELORS AT LAW
a s
April 9, 1984
<� Mr. Ray Swenson
Rt. 3
Milaca, MN 56353
RE: Construction at 5775 Main St. NE
Dear Mr. Swenson:
Our office has been retained by Harry and Joyce Holmberg to attempt to resolve a
problem that exists with their sewer line.
According to my clients and the City of Fridley, the sewer line for the house
constructed at 5775 Main St. NE, was illegally tapped into my clients' private sewer
line. I have reviewed the city sewer plan and concur with that conclusion. Your
sewer line has to go either to the line at 57the Place or 58the Ave. There is no
city sewer line between 5775 Main St. NE and 57the Place.
Because of this illegal trespass my clients sewer line has backed up, flooding their
basement causing damage in the amount of =1,655.35.
Our clients expect to be paid for these damages and demand that the sewer line
from 5775 Main St. NE be removed from their private line.
I have sent a similar letter to the contractor, Larry Steeves and to the City of
Fridley.
I expect a reply to this demand within the next 10 days or I will proceed with the
various legal options available to my clients.
We would like to resolve this matter amicably if possible. Please contact me as
soon as possible with your position.
DB:eh
Labor Came Building. Suite 592
312 Central Avenue S.E.
Minneapolis, Minnesota 55414
f612) 623-4141
JAMES E. BETZ & Associates
ATTORNEYS AND COUNSELORS AT LAW
0
Mr. Ray Swenson
Rt. 3
M ilaca. MN 56353
May 4. 1984
RE: Construction at 5775 Main St. NE
Dear Mr. Swenson:
The Holmberg's would like to be reasonable in this matter, but if you continue to
Ignore our request to discuss the sewer line. I will be left with no other choice but
to commence legal action against you.
If you wish to avoid litigation, contact me next week to discuss the case.
lY.
De ley
DB:eh
Labor Centre Wig, Suite 592
312 Centrai kmrjue S.E.
Miraieapoiis. Mesta 55414
(612)6234141
City of Fridley
sue"Ec'
P RMI
16805.
AT THE TOP OF THE TWINS
r L R'v 1
BUILDING D[ D A A I T
-
i �
•COMMUNITY DEVELOPMENT DIV.
r[p 6 L
i PROTECTIVE INSPECTION SEC.
� a i
' j---1 CITY HALL FRIDLEY 55432NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910415
10/4/82
JOB ADDRESS 5775 Main Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6,7
25
Hyde Park SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Ray Swenson
-MAIL
3 CONTRACTOR ADDRESS ZIP PHONE LICENSE NO.
L/y,�•oF,� Larry Steeves 5611 - 8412 Avenue North 560-0428
�IEwtjNGii�lSENO,
4 ARCT41TECTORDESIGNER MAILADDRESSITC FM
REQUIRED
S ENGINEER MAIL ADDRESS TIh2rF ���Bi� ANt�1�5�G _ PHONE LICENSE NO.
i7 111i1C�
t I�u v
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a Dwelling (Approx. 40' x 28') and a 20' x 22' Gara e
9 CHANGE OF USE FROM TO
STIPULATIONS Provide City with copy of verifying survey before capping. Provide
sod in the front and side yards. Provide a hard surface driveway.
SEWER LOCATION: No Sewer detail - Ask Olson Plumbing
WATER LOCATION: Must be Tapped into 6" main, 10' West of centerline of street.
DRIVEWAY DEPRESSION COST: N/A
(, jy OF PRIMLY DOES NOT GUARANTEE 7hk
call local utiiiti��-...UaACY OF UTILITY LOCATIONS AND EUVATIOVS.
Beive dining DATA IS FOI INFOR"710N PURPOSES ONLY AND
GAS Etc,
TELEPHONE - ELECTRIC - P vs m R GW>UW r►WT illi WOWS T"
REQUIRED 6Y. LAW ok me sm
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
Wood Frame
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 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
l
ISTALLS 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
$50,300
$25.15
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-
$286.00
$425.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
-
$80.08
$816.23
SIG TUREOFCONTR VTpRORAUTHORIZED AGENT iDATEI
WHEN PROPERLY (DATED THIS 15 YOUR PERMIT
O_
8:DG (NSP 1INIATE
S.GNATUREOF VNEROFOWNERBUILDER. iDATEi
7
" CITY OF FRIDLEY
� s3. 16431 UNIVERSITY AVENUE N.E.. FRIDLEY, MINNESOTA 55432
TELEPHONE ( 8/2)571-3450
April 191 1984
Mr. Dale V. Hadtrath
Transcontinental Brokers
534 Plymouth Building
12 South Sixth Street
Minneapolis, MSV 55402
RE: Sewer Backup
H e-Holmbe�
5765 Main Street NE
Dear Mr. Hater
Enclosed is information regarding the sewer backup at 5765
Main Street NE.
If you need any additional information, please contact the
Public Works Department, Mr. Mark Burch, Public Works
Director.
Sincerely yours,
Sidney C. Inman, Director
Central Services
SCI:sh
Enclosure
cc: Mr. David P. Newman
/Mr. John Flora, Public Works Director
PUBLIC FORKS
MAINTENANCE
nATC 4 1 1 a 1 ODA
MEMORANDUM
FROM Ralph VolkmanSuperintendent
TO
ACTION
INFO
SUBJECT
Sewer Connection at 5765
Main Street
Sid Inman, Director of Central
Services
x
Attached is a memo from Rusty Silseth, regarding the sewer connection at
5775 Main Street. This connection was supposedly hooked into the private line
at 5765 Main Street. Rusty says someone from City Hall told the contractor to
check with him about hooking up to the sewer line. This someone was Darrel
Clark. Darrel informed the contractor to contact the Sewer Department before
he made the sewer hookup, so that it was done properly.
Mark Burch also talked with the contractor that was building the house at
5775 Main Street. Mark informed him that the sewer line he planned to hook up
to was a private line, and that he should contact the owners of the home at 5765
Main Street to make arrangements for using their line as a hookup.
See attached building permit and inspectors report of both sewer and water
service. These people assumed that all proper notification and okeys for that
connection were done before they made the inspection.
RV:lp
Attach: 3
PUBLIC WORKS
AIAMENANCE
neTE .__:, ,4 InCA
MEMORANDUM
FROM Rusty Silseth Sewer Foreman
TO
ACTIONj
INFO
SUBJECT
Sewer Connection
5765 Main Street
Ralph Volkman Superintendent
x
On February 14, 1984, Public Works received a call about a sewer backup
at 5765 Main Street. We checked it out and found it to be in the homeowner's
line.
I think it was in the summer of 1982, a new house was built on a vacant lot
just to the north of 5765 Main Street. There is no sanitary sewer in front of
this house, as there was no sewer for 5765 in the middle 19601s. When 5765 was
built, Olbun Plumbing had to run a private sewer line for this house down the
boulevard to S7th Place, a distance of about 175 feet.
Two years ago, I was called to the new house that was being built, and the
house sewer service was being installed. They were hooking up the new house
to the sewer line in the boulevard, that was the sewer service of 5765 Main
Street. I told the contractor to put a cleanout in for each house, which he
did. I okeyed the line as far as the hookup was concerned. Someone at City
Hall told the contractor to check with me about hooking up to the sewer line
of 5765 Main Street.
S&gWECT
RMI
Cite of Fridley
4Pf
_ N 8 0 5
AT TME TOP OF THE TWINS
BUILDING PERMIT
7& 6 2
r
iZ _ _ _ COMMUNITY DEVELOPMENT DIV.
..
PROTECTIVE INSPECTION SEC.
6
! •
i 1 e*"%.; CITY HALL FRIDLEY 654=MYY@Eu
DATE
PAGE of
AVPwp"EO lv
612-571-3450
oto -F15
ry
10/4/82
JOB ADDRESS 5775 Main Street N.E.
1 LEGAL
LOT NO
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESC
6,7
25
Hyde Park SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Ray Swenson "
3 CONTRACTOR MAIL ADDRESS PHONE LICENSE NO
NZIP
] Larry Steeves 5611 - 84� Avenue North 560-0428
A ARG ITECT OR DESIGNER MAIL ADDRESS !IP ^ E SE NO
REQUIRED FM Wffi'
PERMITS
.% PHONE LICENSE NO
S ENGINEER MAIL ADDRESS PLUMBING At4D" I,+•.
�7 r1
EATING.
B USE OF BUILDING
Residential
7 CLASS OF WORK
C NEW O ADDITION O ALTERATION O REPAIR C MOVE Q REMOVE
X
B DESCRIBE WORK
Construct a Dwelling (Approx. 40' x 28' and a 20' x 22' Garage
0 CHANGE OF USE FROM TO
STIPULATIONS provide City with copy of verifying survey before capping. Provide
sod in the front and side yards. Provide a hard surface driveway.
SEWER LOCATION: No Sewer detail - Ask Olson Plumbing
WATER LOCATION: Must be Tapped into 6' main, 10' West of centerline of street.
DRIVEWAY DEPRESSION ODST: N/A
ii - L�IY OF Fj".IDLtY DJES NOT GUARANU lilt
i Ll� V
A=Y OF UTILITY LOCATIONS AND ELEVATIO!'.
Ulllii:°3 s.:. -U S
In !1 I�C31
Boove digs g Ct0%..# DATA IS pM NFORMATION PUCPOSE5 ONLY Mho
. ELEC1111-GAS Etc, a soms u"40 R 6wouw VOST To brobiATCH
TELEPHONE
REQUIRED 6Y LAW 00 TMt 9M
TYPE OF CONST
OCCUPANCY GROUP
OCCUPAt4.Y LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING. HEATING.
Frame
VENTILATING OR AIR CONDITIONING.
ZONING
SO 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 OWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
1 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
$50,300
$25.15
NITN WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$286.00
$425.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
$80.08
$816.23
&C. 'JAE00C0%'R '04011AV7.011ZEOAGEMT GOAT
WHEN PROPERLY DATED THIS IS YOUR PERMIT
,u•.a[:• .:�[a.tpati[aB�.DEo CA•E
CITY OF FRIDLEY
Inspector's Report on Sewer & Water Connections
.'4{"
Street No. -,) 7 7.3� d7,,9/AJ SLIZ c T
permit No; 9,;290 Lot Blk. mac- Addition
Contractor Vt iJ.O�!) 'S PAViiR,,A)G
Type
of
Building:
Residential x Commercial
Industrial
Date
of
Inspection
/oi —j - cP Z Inspector
(t�:'�,
Type of Material
Location of Sewer rlae= r
Meter No.
Size
Location of Water C 0 ,zf
Make Date Installed
6G.& /,0. /A
ter_
CITYOF
FRIDLEY
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E., FRIDLEY. MINNESOTA 55432 • PHONE (612) 571-3450
June 21, 1984
Mr. Harry N. Holmberg
5765 Main Street N.E.
Fridley, MN 55432
Re: Storage of Refuse Containers at 5765 Main Street N.E.
Dear Mr. Holmberg:
Enclosed you will find this department's notice dated June 14, 1984 which
brought to your attention the need to store your refuse containers in
accordance with Chapter 113, Refuse, of the City Code.
As indicated, a reinspection was conducted on June 20, 1984 at which time
it was observed that you are continuing to store your containers in the
front yard. Section 113.08 requires that "Except for the purposes of
collection, all refuse must be placed in the rear of the premises or it
may be placed in the side yard setback, if screened so as to be out of
view fran the street, or in a garage located on the premises..." Only
on the day of collection can a container be placed in the front yard and
then only a maximum of three (3) feet in front of the dwelling.
At this time, the City must require that you bring your property into
compliance with the City Code. To determine compliance with this letter,
a reinspection will be conducted on or about July 2, 1984 and if any
questions or problems result from this letter, please feel free to call on
me at 571-3450.
Sincerely,
6
STEVEN J. OLSON, R.S.
Environmental Officer
SJO/mh
ENC: 1
�• CITY OF FRIDLEY
6431 University Avenue Northeast
A NOTICE OF NON-COMPLIANCE
Name _ � °�� N, 4e_ i -XI
Address 1714"' /i F -
Date
d
tf
Time
of Inspection
An inspection by this Department has indicated that you are in non-compliance with
the following checked (x) sections of Chapter 113, Refuse Disposal, of the City Code.
You are hereby noti;,7ed to ke whatever action is necessary to correct any violations
on or before ®q . Failure to comply with this notice may
result in legal ion by the City Prosecutor.
( ) 113.02 Provide sufficient containers for the storage of all refuse
(including garbage) accumulated on the premises between collections.
( ) 113.02 All refuse containers shall be water tight, have a tight fitting
lid, be impervious to insects, rodents, vermin, and absorption of
moisture, be fireproof, and not exceed 30 gallons in size (unless
otherwise specifically authorized).
( ) 113.02 All refuse shall be stored in approved containers, with the cover
in place.
(r) 113.08 Containers shall not be placed or maintained as to interfere with
the use of adjoining property. For the purposes of collection
only, the containers may be placed a maximum of 3 feet in front of
the dwelling unit.
( ) 113.07 The contents of storage containers shall be collected at least
once every week, or more frequently if necessary.
( ) 113.09 Containers without covers, in poor repair, corroded, or otherwise
defective shall be repaired or replaced.
( ) Other )'X?Aqe_r7C0C
�-
If you have any questions concerning this matter, please feel free to call on us at
571-3450, extension 170.
Insp . By
STEVEN J. OLS N ,''R. S.
Environmental fficer
Community Development Division
CITYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
March 15, 1990 PW90-77
Mr. & Mrs. Ron Brace
5765 Main Street
Fridley, MN 55432
Ms. Susan Griener
5775 Main Street
Fridley, MN 55432
SUBJECT: Drainage Problem - 5765 Main Street
Dear Mr. & Mrs. Brace/Ms. Susan Griener:
On March 12, I visited the site regarding a drainage problem. I
observed storm water collecting at the northwest corner of the
house. When the level gets high enough, it enters the basement at
5765 Main Street through a basement window.
Water collects in this area because it is lower than the
surrounding ground. Due to the elevation of the house in
relationship to the street curb, there is virtually no way to drain
this area to the street. The amount of water collecting in this
area is added to by drainage from the property directly north, 5775
Main Street, which is considerably higher and slopes toward the
south in this area. It would be expensive and difficult to divert
drainage from 5775 away from 5765 and out to the street. The water
problem was made worse this past weekend due to frozen soil
conditions and heavy rains.
An easy and economical solution to this problem is causing the "low
spot" to occur further from the house. . This can be accomplished
by installing a corrugated steel window well (available at local
hardware store for less than $15.00), and placing fill to slope
away from the house. The window well should be placed such that
it extends two ( 2 ) inches or more higher than the new fill and have
eight (8) to twelve (12) inches of rock in the bottom, with the top
of rock two (2) to three (3) inches below the bottom of the window.
The window well should be caulked where it meets the foundation of
the house.
r
Page Two - Drainage Problem -
5765 Main Street
I would suggest that splitting the cost of materials (total should
be less than $100.00 for a load of fill, window well and grass
seed) and labor would be an effective solution.
I would be happy to meet with both parties if I can be of any
further help.
Sincere y,
Mk A. Winson, P.E.
A sistant Public Works Director
MAW/kn
SUBJECT
ER
City of Fridley
29431
AT THE TOP OF THE TWINS
BUILDING
PERMIT`
-------COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
�� ��
r PROTECTIVE
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
j 612-571-3450
910-F15
5/10/99
JOB ADDRESS 5765 Main Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
t.6
25
Hyde Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Rosemarie Sands
571-3845
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
R. Miller Const. 953 Mississippi St. Fridley
571-3514 6354
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP
PHONE LICENSE NO
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION 1E REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house (15 Sq) Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with theState BuildinggCode.
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
SO. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 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
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
$1285
$.64
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIO OF ANY OTHER STA OR LOCAL LAW REGULATING CON.
STRUCT OR THE I ERFOR E CONSTRUCTION
$47.90
Fire SC $1.28
PLAN CHECK FEE
TOTAL FEE
License SC $5.004
1$54.82
SIC NA TU jV0FC 96A4A OR OR AUTHORIZED AGENT IOATEI
HEN PROPERLY
BL
V
"ED THIS IS YOUR PERMIT
��A} I
S-GNATURE OF OWNER tIF OWNER SUILDERI IOATEi
NEW[ l Effective 5/10/99
ADDN [ ] CITY OF MEDLEY
ALTER [ ] SINGLE FAMELY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION A
sg
Construction Address: Mc, .5j ; ri 1�7
Legal Description:
Owner Name & Address: McO`l C TS OtS Tel. #
Contractor:�e ✓1� e�®yl('c! ,,vt/ MN LICENSE #
Address: �l �� M� S�I'�} �� fit I C� Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EMPROVEMENT
LIVING AREA: Length Width
GARAGE AREA: Length Width
DECK AREA: Length Width
OTHER: J�PGe,! �,/ e—
Construction Type:
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Height Sq. Ft. _
Height Sq. Ft.
Hgt/Ground Sq. Ft. _
Estimated Cost: $ �'Llg S
Ft x $
ME
DATE: ,� �� APPLICANT: Tel. # S �`
STIPULATIONS:
M • •
CITY USE ONLY
Permit Fee
$ . 0
Fee Schedule on Reverse Side
Fire Surcharge
$ /, d A
.001 of Permit Valuation (1/10th%)
State Surcharge
$ 6!Z
$.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC Unit
License Surcharge
$ U 0
$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:
M • •