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PRE 2010 DOCSCity of Fridley SUBJECT 3 . 6 3i CR AT THE TOP OF THE TWINS BUILDING PERMIT i may_ - _____ COMMUNITY DEVELOPMENT DIV. �/�F? r � � PROTECTIVE INSPECTION SEC. 1 I � CITY HALL FRIDLEY 55432 NUMBERDATE REV. PAGE OF APPROVED BY 612-560-3450 910-F15 1/29/76 JOB ADDRESS 5712 Matterhorn Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 2 Grace High School Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Mr'. & Mrs. Hille 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Gorham Construction 9050 Collins Drive, Anoka 421-0998 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential -T-CLASS OF WORK -1 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK A Construct a 57' x 44' Dwelling and a 24' x 24' Garage Before digging cell meal utilities . 9 CHANGE OF USE FROM TO REQUIRE® BY LA STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before capping. Provide sod in the front and side yards. SEWER LOCATION: (Approx. 23' Deep) 19' S.E. of Manhole (INV. 933.70) WYE ELEVATION: 933.98 TOP OF FOOTING: 937.98 Minimum WATER LOCATION: 6" CIP watermain 5' East of east property line. MUST BE TAPPED NOTE: The City does not guarantee accuracy on utility locations SEPERATE .PERMITS REQUIRED FOR WIRING, -- IRIPORTANT- HEATING, PLUMBING AND SIGNS. NOTIFY THE FRIDLEY ENGR. DIVISION RE APniNG a, jP SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCC M' VATAND Rf"Ifflek, VENTILATING OR AIR CONDITIONING. Wood Frame AT DRIVEWA THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.AIINGS ` AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION 1274 + 648 25,336 + 6480 OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION Z 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. $40,872 $20.46 WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $58.86 $350.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE Irv-/ 1-30--7{ 1 $429.32 SIG NATURr CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT BLDG. INSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME:_ /y, � /7rj BUILDER: Co ADDRESS:.S7/2- /moi®..tl�r/b<� ��-, ADDRESS:_ - 70,S® Co kvolla„ J -X303 NO: -• i;-7/2- STP.EET: - /`�a �r.h� iN je%' _ LOT: BLOCK: Z ADDITION: M!r / Sr oa CORNER LOT: INSIDE LOT:��_SETBACK: S"® SIDEYARD: Z® Applicant attach to this form Two Certificates of Survey of Lot and propose' building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: c Sl4r r C�<Front: 5-7 Depth: yC/ Height: iJ_ 7' Square Feet: Cubic Feet: 61 Front: 2,�Depth:_ e—*Height: 14 Square Feet;. Cubic Feet: i go of Type of Construction: _ Estimated Cost: _$ 8 %Z , ®v To Be Completed: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict 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: i " 24- - 7( SIGNATURE: 7,iv � (See Reverse Side For Additional Information.) xLT, 1 .P40, Y0 y ELAN, FIELD & NOWAK SURVEYORS 741S WAYZATA BLVD. 11 F MINNEAPOLIS, MINNESOTA As Wjp For File No. 5299 Book No. Z24.85 ............................ 77- P 17 D i2l'V f'.. 7-7 IT- 4) NOTIFY THE FMDLEY ENGR. % REGAPWIG CURB REMO-VAL AND REPLACEMENT A y 0PLN,NGS, -� ;,)Vz1VEWA % 71.8 Zt DESCRIPTION Lot 13, Block 2, GRACE HIGH SCHOOL ADDITION. SCALE: 1" a 30' We hereby certify that this is a true and correct representation of a survey of the boundaries of the land above described and of the location of all buildings, if any, thereon, and all visible encroachments, if any, from or on said land. Dated this 18th day of Ju 1y 1975 9 E G A N F I E L 0 & N 0 W A K, INC. j File No. 5299 Book No. % 93 3, '7 8 21 ", 9� 9�z T E,#!5 r` d F '. 14^rr-r i�- >d . GUA d/U X7-7 T- I` L&V a -97-/0,,V5' 4 P i 8 2 1 1 2 fl' /Z = /S at' B e -� /v , 3_ , 3 X /, d� ��• Or ,2 po , �o 02 Z ��93�® s � d 87z .oa ,;o,- et ao •af � + c '._'^' ,° "-„ r ,a^,> .::'=n .,. - _' .., ,.L� - �. .-_+ 3: _r :4'r '- - -•.r< '.0--...n .z^.':- '.'>.. =�.Y• ..:x -:.:.^r`Yis C//-pp''�� ns ' !!�a� per+? P'- V* -_2f -.Z4) t -d7 s f �L+...,y. r'? � (�...,r'j t?,.7 ",..,,r � •^«q•.: $ �'7'-a—� § G' ..i i'`J b. a��i rev. ..w..e..• '�b.^�oo'�Sia � �b^. ;L hi�nay6av7 ttl. _YT,^! � �a•�.!g� a«r.i l.r�rwl�ri8 `+vy 6f1 =J _ ii°i�td �.�"vrw�d'JC LCrI+ai.A �.tlbF, (omb 3 D t•4v:...3 d•�.i:d .. PARTIAL RATE SCHIEDJLE GcRAV z 'WA?1. d AM: RAIZ 5'07Pet. mace Sisell & Duct Work $10.00 g 1tep:acr-: pr t of Furrta-e 6.00 Papa: -,c & Al:(ra;-ors-_up to $504.00 S'* e RvT2ir-, & :;e:a;:crs each add.:.SOO.00 300 "o 3MCI.L WARM, A%PS P%u - ace S.l ell & Duct Work to 110.DW BTU Slo OO $ e::ch add. V 0 3 BTU — 3.V1 3 RrpTAcvmert of Furnace 6.00 1 3'e°„ airs & A'tP at_rns--uy to $500.00 6.00 $ Rs-„ulrs & Alteratiow each add. $500.00 3.00 S STEAM ca HOT WA= SYST=4 n.:..acr S` e:3 °i L.res— to 410 sq. ft ?.DR Stewn MOO $ 7_rnace Srul & Line—to 640 sq ft. FDR 'Hot Water loco S. Each Add :OO sq. ft EIIR S!"m 3 on $ Each add. 320 sq. ft FDR Hot Water 3.00 S OIL 13IIFNZP—to 3 gaL per hour 6.00 S. over 3 gal. per hour—See free Schedule GAS 3 v ? its Cup to L--9,000 ETU) 5.00 8 aer lX1.000 FTU Soo To* Schodulo GAS F TTINIG FEEZ; NO RATE TOTAL Ist 3 natures ZOO $ AdditSonal 'riztures _ x .75 Cas Range to 199=0 x3 8.40 $_ — State Surcharge .SO ArA C0?.ZD 20Nri?Gr P TAX^�:.: a l''arr 27=1 S--* Tea Di.Tails°LTI^iFi:'a : a's iil:vim aOTZkL --!Z SO ROUGH « lE'� ;kL L / `:r D-Ypt.O$ i:7 g1. &11410 Js�-.moi �. City o4 Frialey: he :n?ersiti..ci hereby mates, application for a pi-rmit for the work her- speca:••d to do all x•erk :n strict accordance with t1he City O-d"zvi.^ ?nd r':'+r.r thr Der : nt r.” i3�,ldir: c, •-73 hereby t1h2l all lic f: and r(•pr-.• mtaticns s;atry m this application are true and exrect. Fridley. F.Lnn `��1�/tl �9 /57 Al. 28 C-?wner Kind of Building . /fiLPi>�J'�J Used To he ror*tpleted a`>out Estimated Cost:. S O!d•—l`Pw. Dwldmg Permit No Permit No. O =ZZC . eiO:i OF W On= MkTTNG or POWER i'LANice•-&:^a.-n, Sot Water, Warta Air -No Trade 'Name __ _— Slse No - Ca paci ty— oCapacity_ _ _ —_ Sq. FL E.D.R BTU F Total Connected 13 v RN ZR - Tree l_L-�d of 1rlrcl Size No t�:aiaatsa-ovaa3 cii-j of IPricll oy . PIIS; ial fOr PluMN S c7ocl Gam e'� ai Sig -..- Dopt. of Bldgs. Phone S$0 -34W . DESCRIPTI011 07 v"OrM. Lo�nLo.L 6-/ l �` / / �"W? Nuzz�r. F.ir.d a.^.d LeerSien of Fixt•»res , p T :~ Estimated Cost, $ =lrl`�� $�i<z ° < 3 u 7<,7y u N 6 ► w wATEa NTA. wsE�Ec. Signed Number Fixtures ............ ... _�.1--- SD �, r1 Future Fixture C�pering ........... —3`/ x $1.50 Iu Nom/ Base e' Business Pl:.jne No ------ N.ew Fixture Old Opening.....:.... ii $�.__. • . Catch Basin .................... x $3.25 $ . Water Beater 'Up to 99.000 BTU). • • • I:: �2 .• ROUGH :`era Ground Run Old Bldg. ........ x ;3.25 S Eloctrie Watar Heatar.....:........ a 52.00 $ FINAL il.S FITT1`IG FEES: NO. R;+TE TOTAL ' v 1st 3 Fixtures .......... . • • • • • • x $2.00- Ad4itdcnal Fixtures .......... , .... x $ .75 $ 2r.d . Gas R:y.Fe to 199.= BTU ........... x $5.00 L State Surcharge Rr—?%I S k ALTEF.ATI0XS--P.afer to Codd .50 .I1 =rIp ion ...............:........ ,...............$ ' TOTAL FT:.E-=� 3rd .... • Futwa Cc: _:.; s:. -a C•�:�a!r�. uciaaz wav Fixrarv. Old O.3r-incs Cczzpcol City of Fridley:. The undersigned hereby makes application for a permit for the work her -ei' specified, aCreeing to do all work in strict accordance with the Cit? O:dirarca and ruling of the Department of BuilLn ,s; and hereby declares that all the fact and representations stated in this application are true and correct' Fridley, Minn / .! 9 IZ6 Owner �z r 6ePi Kind of Building &Z- Used ZUsed as 5-11- 4 L PTo be completed about --- PARTIAL RATE SCHEDULE Estimated Cost, $ Old �w.uilding Permit Ivo. LU�+lBI 0 FIXTU1?E RATES: HO. RATE TOTAL _ : Signed Number Fixtures ............ ... _�.1--- SD �, r1 Future Fixture C�pering ........... —3`/ x $1.50 $ • Nom/ Business Pl:.jne No ------ N.ew Fixture Old Opening.....:.... x $1.50 $�.__. • . Catch Basin .................... x $3.25 $ . Water Beater 'Up to 99.000 BTU). • • • x $3.00 $ .• ROUGH :`era Ground Run Old Bldg. ........ x ;3.25 S Eloctrie Watar Heatar.....:........ a 52.00 $ FINAL il.S FITT1`IG FEES: NO. R;+TE TOTAL ' v 1st 3 Fixtures .......... . • • • • • • x $2.00- Ad4itdcnal Fixtures .......... , .... x $ .75 $ . Gas R:y.Fe to 199.= BTU ........... x $5.00 L State Surcharge Rr—?%I S k ALTEF.ATI0XS--P.afer to Codd .50 .I1 =rIp ion ...............:........ ,...............$ ' TOTAL FT:.E-=� it ♦�..,y.'n. �y+, �we� Fin, ti•.w C"1.,.-,!� �s: ...�{ y�+!'•`..�.:.?-. �,,,, £%»,.� � /�`ep,-1 ..v �.>-.-S�..r••-�E�••. �"�,� a.t�'b�.,::r�]'S �d H:vtavr�i6 •.�..ote� at�t P: c<....so...•�,� �'a�.+�.=d l:•�� .et:::ss:d.aa•va�.s Y.'.v..r+.J.ro�..SL�w� �o.-� ' L':s3 �a.cL1La7tViu.:O� si `al Ji �iail:e� ..::i:.B L.,v v'k Qtriv.11 PARTIAL V,,T[- SCH"EDULE GPtAFTT-f AR34 AIR: RPM TOTAL race Stell & Duct Work $10.00 � Rep'sormt-t of a,rrna" 6.00 8 F.rpa:rc It Altrrat.ons—up to 1.`.00.00 600 S Rrpa:-s lit Aitrra:ions each add. 1504.00 3 W a bmcx. WARM lJR � G� F1:: rsre Snell & Luct Work to I2.0.M BTU eMh add. 10,000 BTU 3.tJU S Prp'accz- crt of c ar's.:ce 6.00 3 R ,,airs & Alte-atior-s—up to $540.00 6.00 $ F_ai s & Alterations each add. S500.00 3.00 $ MAX ox Y_O i WATER SYSTMIA n :..ace ';htll & Lanes --to 4^0 sq. 1t FAR Stent SI0.00 3 Furnace S^:A do Line --to 640 zq ft. EDR Hot Water 1000 S. Each add :00 sq. ft EDR Stesm 3 rA $ F:ac.h add. 320 sq. ft EDR Hot 'Rater 3.00 S _ OIL BUFNZ_R—to 3 gal. per hour over 3 gal. per hour—See Fee Schedule GAS BUIR ER (up to L^-0,000 BTU) ovrr I5?.c'e0 iii.' Sae Foe sch9dL•Is GA3 FITTING V.—IT-3: • No RATr. TOTAL X01, 200 S _ x .75 %$ 5.00 S State Surcharge .SO Soo Fco Scb .zt£► TOTAL 2 S 6.00 S. 5.00 S Is -1 3 F.xtures Additional Fixtures Gas Range w I99,= AIR Com.:.;:tIOCIT:G' EYE —1—P14 o c " ui%Z G 5= Ing ALT :iAT1CN3 &, rZPA3S Rt3E3GH Dopt. of cal %a. M, D-V.M VL t� City of Fridley: The undersigned hereby makes. application for a permit for the work 3ercir specified agreeing to do all work in strict accordance with the City Ordt:a=cev and ruiing•of the Pepa:tmrnt of Buildir.,;s, and hereby decla:;s that all the f:. --u and reUrrsPntatiun;. stated in this appbe2lLicn are true and correct Owner x' Kind of Building Used as To be completed about Estimated Cos;, S Old olNe,Building Permit No. _:__ ._ permit No. HEATING or Trade D=r/ C -L- =0AN OF cT0'.1= Set Water, Warm Air—No G� Size No&,�Zr Capacity �� 'SG. Ft, F-D.R B—,U-- Hp Total Connected I.a: 11;i -d of i'Lvt � BURNER — Tirade Home Size No cap,cl Sq. F'3. ED R- BTU _Q ifV+'4E4Ra? OYSRj • vim. � �/ ' 1 SUBJECT P City of Fridley 179 AT THE TOP OF THE TWINS BUILDING PERMIT _ • COMMUNITY DEVELOPMENT DIV. ; �: ------ r PROTECTIVE INSPECTION SEC. 5 77 % 1 � ; l 1'-',,� CITY HALL FRIDLEY 55432 A-If NUMBER REV. DATE PAGE OF APPROVED BY ---- L 612-571-3450 910-F15 5/6/85 JOB ADDRESS 5712 Matterhorn Drive N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 13 2 Grace High School Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lawrence Hille 5712 Matterhorn Drive N.E. 571-5736 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 f� ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE' 8 DESCRIBE WORK Construct two decks 12' x 12' each 9 CHANGE OF USE FROM TO STIPULATIONS Nun Before digging caj, loc., ut91ltiES TELEPHONE - ELLami -,GAS Etc. REQUIRED SEPARATE PERMITS REQUIRE® FOR _ BY LAW WIRING, HEATING, PLUMBING AND 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,800 $.90 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $29.50 LAN CHECK FEE TOTAL FEE 7.38 $37.78 SIC TURF OF CONTRACTOR OR ZEDAGENT MATE)WHEN PROPERL IDATED THIS IS YOUR PE MIT �� BLDG INSP s - F)AT SIGNATURE OFOWNER [IF OW ER BUILDERI IDA EI NEW [ ] City of Fridley ADDN. I R-1 AND R-2 ALTER. I ] �xf syr, dor-K Building Permit Application Construction Addri Effective 4/1/84 Legal Description: 1 oTft e1h Owner Name & Address:-1-a",eer.e2 ��r%%- Tel. i&571 -s736 -� Contractor: -F Tel. # Address: ] 1'K Me'l yrhorn bl" v-� 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. NY OTHER: M�o Corner Lot [ ] Inside Lot [,Ij Ft. Yd. Setback Side Yard Setback ,moi wood decj l --j Type of Construction: Ir id '(Va -c Estimated Cost: $ UCxJ Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: APPLICANT: Tel. # V02-7607-40 CITY USE ONLY Permit Fee $ a 9, -0 Fee Schedule on Reverse Side Plan Check $ 9-19 25% of Building Permit Fee State Surcharge $ Au #.50/$1,000 Valuation SAC Charge $ $425 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ TOTAL $ Agreement Necessary [ I Not Necessary [ ] 3 STIPULATIONS: SUBJECT PERMI O. City of Fridley o 1999'7 AT THE TOP OF THE TWINS BUILDING PERMIT _ r RECEI � 1 `L ______ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. �� 1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L J\� 612-571-3450 910-F15 7/14/89 JOB ADDRESS 5712 Matterhorn Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 2 Grace High School Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lawrence S. Hille 5712 Matterhorn Drive N.E. 571-5736 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install skylight in living room 9 CHANGEOFUSEFROM TO STIPULATIONS 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 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 1 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 $50.0 $.50 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- STRUCTION$15.0,0- OR THE PERFORMANCE OF CONSTRUCTION. plLAN CHECK FEE TOTAL FEE $15.50 ZEDA ENT IDATEI SIGNAT R OFCONTRACTORORAUTHI.A.- WHEN PROPERLY V LI DATED THIS IS YOUR PERMI j 1 ,=PE �6L ! - SIGNATUREOFOWNERIIFOWNER BUI D I 1 ATEI BLDG INSP DA NEW [ J ADDN [ ] ALTER Construction Address: 521 Legal Description: R-1 AND R-2 Building Permit Application M Effective 5/1/88 Owner dame & Aiadress : He— Tel. # � Contractor: Tel. # Address: % 0- M a fie D r Attach to this application, a Certificate of Survey of the lot, with the prcposed construction drawn on it to scale. MING AREA: length Width Height Sq. Ft. GARAGE AREA: length Width Height Sq. Ft. HECK AREA: length Width Higt/Ground Sq. Ft. Corner Lot [ ] Inside HAt Type of Construction: Approx. Ompletion Date: L ] Ft. Yd Setback Side Yazd Setbacks Estimated Cost: $ 5-06 - r -6, 4 4a-� Proposed Driveway Width If New Opening Is Desired: Ft. $ $ Width + 6' See Back Page DATE: / APPLICANT: G w l'I r �� Tel. # Permit Fee $ X a State Surcharge $ SAC Charge $ Driveway Escrow $ Park Fee ., $ Sewer Main Charge $ STIPUTATICNS: QTY USE COY Fee Schedule on Reverse Side $.50/$1,000 Valuation $575 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY INSPECTION DIV. Effective On August 1,1995 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION.AND AIR CONDITIONING SYSTEMS AND DEVICES. RATE SCHEDULE Residential Rate TOTAL Furnace Shell and Duct Work, Burner — Also Replacement Furnace $ 30.00.• $ (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) $10.00.' $ Gas Range $10.00 $ Gas Dryer $10.00 $ *Air Conditioning — All Sizes $ 26.00.: $ All Others/Repairs & Alterations (LIST ON BACK) 1% of Value ptAppliance or Wo/k _ $ Commercial/industrial 1.25% of Value of Appliance or Work State Surcharge $50_ Z) TOTAL FEE $ MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION 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. JOB ADDRESS 5'71 Ma /'/Pckc ,, A 12ri V , •;The undersigned hereby makes application for a permit for the work herein specifiiad agreeing to do all work in strict accordance with the City Codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. ,1995 s OWNER �•. Ci r ✓� c 2 5 l�li'(} le BUILDING USED AS ESTIMATED COST S PERMIT NO. No. of,Heating Units_ Circle One (Steam) (Hot Water) (Harm Ajr) Trad"ame Size No. L BTU HP EDR Fuel -A! 411 v afL Gas Total Connected Load Burner -Trade Name, BTU* ' Size No. HP EDR HEATING COMPANY Signed ByJc. ,�� ;e..— �f �,�G'� Tel No. S 71 — �7 �i i� y 0r - X07 CL) Approved By 046 Rough—In Date Final Dated 't 5zfe FILL OUT BACK SIDER STACK VERIFICATION ON 4 REPLACEMENT FURNACE -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: CHIMNEY 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 ( ) S. 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: SUBJECT MIT NO. City of Fridley 25069 AT THE TOP OF THE TWINS BUILDING PERMIT r -- RECEIPT NO. � • _____ COMMUNITY DEVELOPMENT DIV PROTECTIVE INSPECTION SEC. a r � � 1 � NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 612-571-3450 910-F15 5/16/97 JOB ADDRESS 5712 Matterhorn Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 13 2 Grace High School Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lawrence/Meredith Hille 5712 Matterhorn Drive NE 571-5736 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 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 Reroof House & Garage (27 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Roofing started without permit - Ice and water was not installed on the north side of house. Roofing does not meet the State Building Code. TYPE OF CONST. OCCUPANCY GR p UP 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 6FFSTREET PARKING 1 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 $2,227 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE S C CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $74.75 ire SC $2.23 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE T TALFEE $78.09 WHEN PROPERLY V DATEDTHIS IS YOUR PERMIT SIGN fT RE OF CONTRACTOR OR AUTHORIZED AG T (D TEi P . BtDG &P a I )ATE SIGNATURE OF OVVN.rR,iF O WLD Ri (DATE) NEW [ ) Effective 1/1/97 ADDN (J CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: r Legal Description: 1 57�--9 3 Owner Name & Address: %,C',, ylo , �%1pr ��i (��/�� Tel. #_C7 2d 6 A 31 Contractor: x214 MN LICENSE # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OT Rlei: rao �v a % S , A � �PG r a f"f' y Construction Type Estimated Cost: $ U (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $_ _ $ DATE: T APPLICANT:L� ;^�Q ��,�� Tel. #I �73 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ fly- 7. ' CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $950 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 [ ] CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE Residential APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace) C69s-�;,eplGc ,,A4"I'lr) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK 1 % of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $ $10.00 $ $10.00 $ $10.00 $ $ 25.00 $ State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION 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. Effective On January 1 j 1998 JOB ADDRESS 5/ 1 a "p rko r+-, Or 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 Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. 01998 OWNER BUILDING USED AS Pe s; ESTIMATED COST PERMIT NO. /3 ,.�- DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Trade Name Circle One (Steam) (Hot Water) (Warm Air) BTU 3 5-000 HP Size No. _ EDR Fuel iv*dva Q (,I s Total Connected Load Burner Trade Name _ „ - G/o Size No. BTU HP EDR HEATING COMPANY Signed By , V If % Tel No. Approved By Rough -In Date Final Date % FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: Yes CHIlV 4EY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: No 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 8. Has combustion air been provided for water heater Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: Yes No Yes () No ( ) ` CITY OF FRIDLEY PERMIT NO.: 2005-00223 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 02/23/2005 763) 571-36U4 JFAX: (763) 571-1257 ADDRESS 5712 MATTERHORN DR NE PIN 243024240015 LEGAL DESC GRACE HIGH SCHOOL ADD : LOT 13 BLOCK 2 PERMIT TYPE BUILDING PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE : ROOFING VALUATION : $ 3,100.00 NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE. STATE LICENSED CONTRACTOR 1 APPLICANT BUILDING PERMIT FEE FIRE SURCHARGE 97.25 3.10 HALDERSON SCOTT CONSTRUCTION 7233 COUNTY 3 SW STATE SURCHARGE, VALUE 1.55 COKATO, MN 55321 LICENSE SURCHARGE 5.00 (320) 286-7004 TOTAL 106.90 PAID WITH CHECK # 4028 OWNER HILLE LAWRENCE S & MEREDITH 5712 MATTERHORN DR NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and convect. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date, SEPARATE PERMITS REQUIRED FOK WUKK U I HLK i HAN Ut 6L ►citsr;U Ar5Uvr;. F - - 6a3 NEW [ ] CITY OF FRIDLEY ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: 5'7) 2 Yla-Haf 6 r ,,\ i r, , Ff, . d %e., P) /,J - '-" 3 c Legal Description: a 4 L le L I L o t /a Owner Name &AddresJ Tel.# 7.63-S7/�;73� s: 7� J2to h r, �^ Contractor: 5-( 0-+ l'0,0 rI CA in �o � o MN LICENSE # �e—o2G338�g? Address:��-k� g�Q 3 S'G/ COk4-1-p /2*,�r3I Tel. #. -?,)6 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 DECK AREA: Length OTHER: Width Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft Construction Type: ��AThlT�� S� Estimated Cost: $ ®® Ob Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ / �l-- DATE: ~� APPLICANT: Tel. # Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY - $ C-1, 5 Fee Schedule on Reverse Side ':�. 10 65% of Permit Fee $ 1 -55' .001 of Permit Valuation (1/10th%) $ $.50/$1,000 Valuation $ $1450 per SAC Unit $ S-�`$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 [ ] $ ® 0 STIPULATIONS: Building MECHANICAL Permit No.: — Inspections RESIDENTIAL APPLICATION Received By:� 763-572-3604 CITY OF FRIDLEY Date RW_C-"4 DATE S -� -o-1 YOUR E-MAIL ADDRESS �U Z /earn F. A lQ� o C�cn n pa�� u s r edjy7 SITE ADDRESS THIS APPLICANT IS: 0 OWNER CONTRACTOR PROPERTY NAME: / ADDRESS: CITY STATE ZIP OWNER/ TENANT PHONE: /0rev /Y ,�' CONTRACTOR _ � /��Y COMPANY NAME: �DA0 � VLIINtt'tn (L S r I r-t— CONTACT PERSON: c,7h'7&iLK! 1`-t li &4 N ��leveEr�J L leklb SUBMIT A COPY OF r YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH ADDRESS: iqz.I 3 Ulf �koy /j ISh/ CITY STATEWAJZIP 553.7/ APPLICATION PHONE age 3 3 FAX PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE. TYPE OF WORK: 0 NEW [REPLACEMENT El ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK S (a..c.- c�ctj r1,cc.ja-e &lj!+ 06ytd.,- �yruo PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF LOW) Equipment Installedaped MFG: LIaL7`i0L MODEL: C° Lc MPV-(tw--11 0 SIZE/BTU 110,000 MFG: _U7"XLcW_ MODEL: k 17 1&-m4 -Z3o SIZE/BTU S MFG: MODEL: SIZE/BTU t A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00 _AIR $35.00 1 FURNACE $35.00 _GAS UNIT HTR $10.00 _BOILER _CHIMNEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00 _DUCT WORK $10.00 _GAS PIPING $10.00 _VENTILATOR $15.00 PERMIT FRE PROJECTS FOR VNMA $5#10 PERMT FEE FOR PROJECTS OVER $500 Permit Fee $ to D . Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ to6.,5 Number of fixtures @ $25.00 1 x $25.00 = $ Number of fixtures @ $35.00 1 x $35.00 = $ State Surcharge = $ .50 Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case oif all work which requires review and approval of plans. r ` OF APPLICAXI_ / E, PRINT NAMDATE 5--7 -0-7 SIGNATURE _iQVIJI . -;:_,,,PLEASE NOTE: SEPARATE PERMITS...ARE REQUIRED FOR BUILDING, ELECTRICAL ANIS MECHANICAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 200% Building BUILDING Permit Ivo..) 0 0 q _0 0& 5 0 • Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: gwt t®°1 763-502-4�L9.77 FAX EFFECTIVE 1-1-09 DATE��ot l o� UDR YOUR E-MAIL ADDRESS J S k I le &— m s n, SITE ADDRESS 57 1A M ot% t r6'v% T) 1^ r\.) E THIS APPLICANT IS: RIOWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: oe re d t t - ill e TENANT ADDRESS: S 7 l a M P 1 to r kca r v\ 1)r• N44TY E r f a STATE ZIP PHONE: % 6 3 - '57I - S7 3 CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # EXP DATE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ,S:pECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR til5tEMODELING DESCRIBE WORK BEING DONE: J Gi t`x u; IJ J ee_k SIZE OF IMPROVEMENT / LENGTH 3 WIDTH a HEIGHT SQ FT o� 7 ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other El Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes []No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF. WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING TIDE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $_ 3� �[L} . �Q OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $2000 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$22=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of alworkwhich requires review and approval of plans. . t SIGNATURE OF APPLICANT p� C AA_A- ti u^� �l PRINT NAME �Q w T P vC Z g/t' 1% DATE a I e)el