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PRE 2010 DOCSCity of Fridley, Minn.. BUILDING PERMIT N° �35 Address Address ,Cy 10N OFd ILDING No. Street �'1 Part Lot Lot Block Addition or Sub.D1vlsi2 Corner Lot Inside Lot - Setback —+__ _ Sideyard _,C 0 Sewer Elevation _ _ — Foundation Elevation DESCRIPTION OF BUILDING t)o' r' r%�yFront Depth Height og� Sq. FkCu.t —Depth Rc:,gHeij Sq. Ft. Cu..tion ' Est. Coat o be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do theproposed work in accordance with the description above set forth and in compliance with all provisions of MM= of the city of Fridley. In consideration of the payment of a fee of -11 , 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 me in, around and upon said building, or 'any art thereof, shall conform 'in all respects m 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 tune upon violati6 of any of the provisions of said ordinances. Building Inspector NOTICE: This permit does not cover the construction, Installation for wiring, plying, gas h8etine. Sewer or water. Be wire to we the Building Inspector for separate permits for these. items. .OW4 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner's Name �� L fJT�R ��� i �S a'NC. Builder SARA ,F- Address Sv'rs roq 600 A -W, 41zke Address iUrc9uE�P®zip �� LOCATION OF BUILDING No. Jra R ?____Street Part of Lot Lot Block Addition or SubdivisionJ'JvsW0� 1 Lr � a Corner Lot Inside Lot Y,�Setback j Side -Yard to 'fin& 6 o K it SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: RP S r b a' c FrontDepth `� - Height '7L- 6 Sq. Ft. 1 Cu. Ft. `31 i HO 3 ,4- t A, 6 ,4 C-- D CA(?A 6 9" FrontP P"Depth 3� C Height i dL- ` Sq. Ft. 14 4 6 Cu. Ft. 5 '70 Type of Construction�z�6�� �Nfd2- Estimated Cos a®,Q®® ,.E� To be Completed &-y—E, 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 factrepresentations stated in this application are true and correct. /I I DATE /-� �� SIGNATURE (A Schedule of Fee Costs can be found on the Reverse Side.) City of Fridley Application for Plumbing and Gas Fitting Permit DESCRIPTION OF WORK Number, Kind and Location of Fixtures qp ya Number Fixtures ...................... x $1.50 3� o� ,i 8� 5� <3 d �d 0 z �p � F it N WATER HTR. GAS ELEc Base rl GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... ! x $1.50 $ / Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............., x 2.00 $ 92? 1�0 REPAIRS & ALTERATIONS—Refer to Code 1st !� TOTAL FEE 0 2nd _ 3rd 4th • Future Conaectfoa Openings Now Fixture, Old Openings I Connected with Sewer � Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TCAAL Number Fixtures ...................... x $1.50 $ �0 Future Fixture Opening ................ !N4 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 $ / Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............., x 2.00 $ 92? 1�0 REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE 0 Dept. of Bldgs. Phone �SjUe4-74f0 City of Fridley: The undersigned hereby makes application for a permit for the work hereir specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. ®® dley� Mann 19A/ Owner Kind of Used as To be completed about Estimated Cost, $ /& fti—New. Building PermitNo ` � � � Permit No. ROUGH FINAL /P Signe By Business Phone No �` r /1 Application for Power PMm is and Heating, Cooling, Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SII 4-7470 GRAVITY WARM AIR: RATE TOTAL Location s /%��fi�A/"� Or"jje Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECIL WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ .o each add. 60,000 BTU ....................... 2.00 $ -- Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up-to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OV- BURNER—to 3 gaL per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.5o $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE S 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, � �� / 1�i Ownerg 195— Kind of Building 195 Used as 4�ozyLt' V d9 To be completed about /® s`''e Estimated Cost, $ Old New uilding Permit No. J i'4 DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Wates, Xar2i] �No.__ L Trade Name_- Cel Size No-"-) 10 -12-0 Capacity- l L® / Ft. E.D.R BTU H.P. Total Connected Load 6 �o®� Kind of FuAso e BURNER — Trade Name '/ -.,P— Size No Capacity Sq. Ft. E.D.R BTU H.P. Sign B -olEloll POST IM -12-58 Business PhoneNo- -4 T ✓� %/ I;TOSS LCALCULATIONS DEPARTMENT OF BUILDINGS ,E:Weatherstrips A.S.H.V.E. Construction. No. Guide WindowsI Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Yes—No Yes—No 19— i FI-�. �'.' R.. I irnath ie io V Width B 1 4+•. I-Ieiaht _ II Flf' q Windows an Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crac sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lighta of crac eq. ft. Width Height No. of Lineal ft. Areak No. of pane of pane lights of cracsq. ft. cd t4 $ Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. ofpane of pane lights of crack eq. ft. Coef. Btu Coef. Btu Infiltration Infiltration Infiltration Glass °9 Glass Infiltration . �"` " &� , 0 Exp. wall Is �; �` �., Exp. wall Net exp. wall ! Ceiling' Net exp. wall 2. Int. wall `` "zj Int. wall Ceiling Ceiling Ceiling Floor Ceiling Floor Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area " ft Fl.1 C) ,' Room I Length f 1Width ,4i 1 Height Windows and''Doors—Crackage and Area sl ­ Width Height No. of Lineal ft. Area No. of pane of pane lights of crac sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lighta of crac eq. ft. ca.♦ .l 3. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. ofpane of pane lights of crack eq. ft. Coef. Btu Infiltration Coef. Btu Infiltration Infiltration Glass Coef. Btu Infiltration a C� 5' Glass Exp. wall °. Glass Is �; �` �., Exp. wall Net exp. wall ! Ceiling' Net exp. wall 1 �' '' `` "zj Int. wall Ceiling Ceiling Floor Ceiling Floor y N Floor Required sq. ft. E.D.R. or sq. ins. WA. Leader' area rn1 .— n- Ir A tvc1.1 ,a 1.. 41, V-0 sl ­ Width Height No. of Lineal ft. Area No. of pane of pane lights of crac sq. ft. Windows and Doors—Crackage and Area Win ows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. ofpane of pane lights of crack eq. ft. Coef. Btu Infiltration a Coef. Btu Infiltration Glass Coef. Btu Infiltration Glass Exp. wall °. Glass Is Exp. wall, Net exp. wall Int. wall Net exp. wall Exp. wall `9 ! Ceiling' Net exp. wall 1 r Cygo Int. wall Ceiling Ceiling Floor Floor y N Total Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area 5-7, 0 ZV S 7'd MNNEAPOLIS, MINN. Insulation Kind How Applied 'I"OOIU I LLCUSLU nauua Width Height No. of Lineal ft. Area No. of pane of pane lights of crac sq. ft. Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Coef. Btu Infiltration a Coef. Btu Infiltration Glass 1L f C Glass Exp. wall Floor Is Exp. wall, Net exp. wall Int. wall Net exp. wall ! Ceiling' p7• r Cygo Floor Ceiling Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI I . d. Rnnrn I 1 math _ Width -� Y Height '7-' Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crac sq. ft. Width Height No. of Lineal ft. Area No. of pane of.pane -Its to of crack sq. ft. Coef. Btu Coef. Btu Infiltration a Glass Exp. wall �"- Glass �. - Iry Exp. wall Floor Is Net exp. wall ! RIC". Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area i CI I _ . n-_— I r ---.L VFRA&L F Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of.pane -Its to of crack sq. ft. Coef. Btu Infiltration .• a Glass Exp. wall Net exp. wall is Int. wall �. - Ceiling Floor Total Btu.At , ' Required sq. h. E.D.R. or sq. ins. W.A. Leader area D-36 79 HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS IMMEAPOLIS, MINN. Weatherstrips A.S.H.V.E, Construction No. Insulation Guide WindowsI Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Ws -NO Yes—No 19— F1.I.7 as � 4 Room I Length Width Height h.o II Fl.l Room I Lenath Width Height Windows ana Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of�pane lights of crack eq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal f . Area N of Dane of p e light,of crack eq. ft. Coef. Btu Infiltration Glass Coef. Exp. wall _ r,jo Coef. Btu Infiltrationr Int. wall Ceiling cin Y, Glass y un Glass c,,�� w` Exp. wall - 150 711 CIL, Exp. wall` Net exp. wall ref 9� Net exp. wall Int. wall 1 Int. wall Floor Ceiling 22`° t� Floor Total Btu. 1 5 (11 15 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.� mIt m Length ..� a - Width �' Height a.< -� Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of�pane lights of crack eq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Coef. Exp. wall _ r,jo Infiltration Net exp. wall Int. wall Ceiling cin Y, Glass Floor ele Total Btu. '11 - Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 m I Length –'7-' Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Coef. Btu Infiltration Net exp. wall Int. wall Ceiling Glass Floor . c,,�� w` Exp. wall - , Net exp. wall ref 9� Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.l Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Application for Power Plants and Healing. Cooling. Ventilation. ReFri enation and Air Conditioning Systems and Devices g PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ............................ 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ....................... 2.00 ;- Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ..... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water ....... ...... ... 2.50 $ OIL BURNER—to 3 gal. per hour 5.00 $ over 3 gal. per hour --See Fee Schedule GAS BURNER (up to 400,000 BTU) . ............... . ... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $� Additional Fixtures x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $,-6�-�=- PAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ SSD Dept. of Bldgs. Phone 5M-3450 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, Owner Kind of Building Used as To be completed about ! Estimated Cost, $ Old New. Building Permit No. (3.35 Permit No. (® r DESCRIPTION OF WORK HEATING or POWER PLANTS -Steam, Hot Water, Warm Air—No Trade Name Size No. Capacity. 19 4 Sq. Ft. E.D.R BTU H.P. Total Connected Load Kind of Fuel BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. ROUGH �3i�G `i% T — - ` e <-- . 42 FINAL (REMARKS -OVER) a .� MEMO TO: Marvin Brunsell, Finance Director MEMO FROM: Richard N. Sobiech, Public Works Director DATE: July 22, 1977 SUBJECT: Claim Against City From Resident at 5291 Matterhorn Drive NE (Marshall Lind) Please note attached correspondence from a resident at the referenced address. They are claiming the City of.Fridley caused some damage to their water softener and are suggesting we reimburse.them for the replacement of the water softener. Could you please forward on to our liability insurance company for processing? Also, could you please let me know the results of the claim so we can notify the resident of the outcome of the claim. Thanks for your help. RNS/jm cc: Marshall Lind M w i -'1 COMMERS SOFT WATER CO. 3 301 CALIFORNIA ST. N.E_ r i0m RM OEM Pica 57047 MINNEAPOLIS, ��i0 '10 3r8 a MINN. 55421 DATE OR OR�D/vt � /"" —7. CUSTO-ALR S OR^vER NO. PHONE HELPER S'rARTIN3 DATE �11-67 I Bt_L TO � 5 � ORDER -TAKEN BV s d ADpRE55 ❑ DAY WORK Q CONTRACT clrr �y ❑ EXTRA JOB NAME AND L01-ATION V �j 3 1 DESCRIPTION Cr '::JRK; - - _---- �L �— - 02 f --- --------------- TOTAL MATE R!4! ---------- ----- ------ _TOT-L-AB—i TAX j i - Q ] tlo one `,cmn (_] c,S ti 4mou ' dine Tota' b tun2 to � icr, , hove a rk: or bamailed tailed ef'.ar I Fare-- i�c!3F ; --— COripletiOl say ;facp.:y ccs ; 1 'inn <�I ''jQrR I . C17YOF FMDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 August 9, 1990 David and Geraldine Johnson 5291 Matterhorn Drive N.E. Fridley, MN 55432 RE: Property at 5291 Matterhorn Drive N.E. Dear Mr. and Mrs. Johnson: On July 1, 1990, the City of Fridley began a new program called Systematic Code Enforcement. This program is designed to provide fair and equitable code enforcement, improve the City's appearance, and maintain property values by creating a more attractive suburban environment. Under this program, all properties in the City will be inspected approximately once each year to ensure that they are in compliance with the Fridley City Code. A recent inspection of your property revealed that not all Code requirements are presently being met. Listed below are item(s) which do not comply with the Code: 1. Discontinue outside storage of sawhorses, basketball hoop, and assorted materials located in the front yard and driveway areas. Your prompt attention in correcting this problem would help us in our effort to improve the City. A reinspection will be conducted on or about August 23, 1990, at which time compliance is anticipated. Please call me at 572-3595 if you have questions or wish to discuss this further. Thanks for your cooperation! Sincerely, Steven Barg Code Enforcement Officer SB:ls C-90-618 SUBJECT City of Fridley0 C3: 4 3 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. _____ f � - PROTECTIVE INSPECTION SEC. 6�' 1 . � NUMBER REV DATE PAGE OF APPROVED BY 1 = I CITY HALL FRIDLEY 55432 612-571-3450 910-F15 10/25/99 JOB ADDRESS 5291 Matterhorn Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 1 Innsbruck, 1st Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE David Johnson 571-2713 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO New Haven Constr. 4208 83rd Ave N Brooklyn Pk5544 66-5225 20077950 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW 0 ADDITION 0 ALTERATION 01: REPAIR 0 MOVE O REMOVE 8 DESCRIBE WORK Reroof house and garage (31 Sq) Tear -off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 2709 $1.35 DOES NOT PRESUME TO GIVE AUTHORITY O VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STA OR L CAL LAW REGULATING CON- STRUCTION OR THE PERFO A E OF C NSTRUCTION $83.25 Fire C $2.71 PLAN CHECK FEE TOTAL F ice SC 5.0 9 . 1 SIGN4 RE OF CONTRACTOR OR AUTHORIZED AGENT IOATEI ENMOf!LI DATE W TA4S IS YOUR PER IT BLD IN$p - • rIAiE dr S-GNATURE OF OWNERJF OWNER BUILOERI IOATEI APR -14-1999 NEW- ! 1 ADDN [ l ALTER C ] ConstructionAddress: 11:34 FROM CITY OF FRIDLEY TO CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R -Z BUILDING PERMIT APPLICATION rr? %U/ -/k& 5667183 P.01i02 Legal 1J gal Owner Name & Address: moi' �//al � %i/�50� Tel. # - � % � r/�� /� ��� MN LICENSE lI Contractor• /_v z�/ _ a -S Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF PAPROVEMENT LIVING AREA: Length Width Height . Sq. Ft. _ ---r Width Height Sq. Ft. GARAGE AREA: Length Width Hgt/Ground Sq. Ft. DECK AREA: Length OTHER: Construction Tylc �&60 F Estimated Cost: $ (Fee schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $- DATE:�O w APPLICANT: y/ /V,-,-,Sc/�� Tel. l� Permit Fee Fire Surcharge State Surcharge $ e $ SAC' Charge License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee $_ Sewer Main Charge $ TOTAL $�� STIPULATIONS: CITY Ui&—QNLy Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.501$1,000 Valuation $1050 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 [ ]