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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 • •