PRE 2010 DOCS11
Date: — 5-
6
Owner:
Address
City of Fridley, Minn.
BUILDING PERMIT
77/%
N? 4492
Builder ............ 21:7.. ....... ....__....
Address
LO ATION F BUILDING
No... ../......... Street ..Q 3- ......; ......... ...I .....................:.... Part
toofoLot ................................... -�•---- •-----------......._.._.
Lot ....... � _..L....-........ Block ...........3 ......_.................... Addition or Sub -Division .(/,7 � 7 ��4� '...a.._1s
Corner Lot ................................... Inside Lot ..._ ...................... Setback ......... .. ............. Sideyard/_0........................... _............. _..........
SewerElevation .. ... ............................. --............_..................................................... Foundation Elevation ............................ ....... .............. ------------. •-•--.........---....---------
DESCRIPTION OF BUILDING
To be Used as: / ,�
'�..... Front Y....1 Depth.......... Height<.......... Sq. Ft. /..... Cu. Ft�._..1..!....��
Q -. Front d.:,7.--..... Depth ...._./„t Hei ht ../...C:>_..... Sq. Ft �`�..a�... Cu. Ft. ��i1
Type of Construction ... ... Est. Cost',t. Y ................. To be Completed .------------------...----- --
In consideration of the issuance to me of a permit to cons ct the uilding descr' Ild ove, I o do
the proposed work in accordance with the description above et forth d in co p ' c th all t` 'ions of
ordinances of the city of Fridley.
... ............. _..._............._.........._....
In consideration of the payment of a fee of $.12.......................... permit is hereby granted to ..... _............. -.............
........................................_........ to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. '-- 117, /-,—)
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
4
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
CLEMRON, INC.
Owners Name Builder ENTERAL CONTRACTORS
' 2500 22nd Ave. IST.
Address Address.�Wuu% ®T3� 1�, Minn.
LOCATION OF BUILDING
Ao. Stseet Part of tat
Lot Block _;,Addition or Sub. Di►v.
Corner Lot I71side Lot Set Bask ..�..�..
Applicant attach to this form Certificate of Survey of LSt and proposed
building location.
DESCRIPTION OF BUILDING
To be used as
O' Front- '�DepthHeight gL
Sq. Ft. ,�P_.__._ Cu. Ft.
_ 1
' Front ........ Depth „ 1 weight IL
*pe of Construction
To be completed
Estimated G
Thd'•undersigned hereby makes application for a permit for the work
here'lh•spe,cified, agreeing to do all work in strict accordance with the
City Ordinances and•ruling of the Department of Buildings, and hereby
dgalares that all the facts and representations stated in
are -true and cor eat.
DaU -. Signat e
(A Schedule of Fee Costs can'be found on the Rever
Ll
City of Fridley
Application for Plumbing and Gas Fitting Permit
DepL of Bl gs. Phone SII 4-7470
DESCRIPTION OF WORK
Number. Kind and Location of Fixtures Location
G7
C
RATE
TOTAL
Number Fixtures ......................
x
$1.50
$ C1. 0-0
Future Fixture Opening ................
K
1.20
$
New Fixture Old Opening ..............
w
z
•
•
N
WATER HTR.
GAS
ELEC.
Base
x
2.00
$-2,6--o
New Ground Run Old Bldg. ............
x
3.25
$
GAS FITTING FEES:
NO.
RATE
TOTAL
1st 3 Fixtures ..........................
x
$1.50
$ ' 5-0
Additional Fixtures ....................
x
1st
$
Gas Range to 200,000 BTU ..............
x
2.00
$
2nd
3rd
4th
• Future Connection Openings
New Fixture, Old Openings
Connected with
.Sewer
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures ......................
x
$1.50
$ C1. 0-0
Future Fixture Opening ................
x
1.20
$
New Fixture Old Opening ..............
x
1.00
$
Catch Basin ............................
x
3.25
$
Water Heater (Up to 200,000 BTU) ......
x
2.00
$-2,6--o
New Ground Run Old Bldg. ............
x
3.25
$
GAS FITTING FEES:
NO.
RATE
TOTAL
1st 3 Fixtures ..........................
x
$1.50
$ ' 5-0
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley, Minn ) r //6 , 19
1 �O
Owner ` ' t` T A� 19
Kindof Building , 19—
w A
Used as
To be completed about
Estimated Cost, $
,Xd. Building Permit
Business Phone
RE'
N
.QW11 POST IM -12-58
Applicarion for Power Plants and.Heating, Cooling, Ventilation, .Refrigeration and
Air Conditioning Systems and Devices
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 ............................. .#.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 BTL) ....................... 5.00 $�
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x $1.50 $ L�
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH-
OUGH
FINAL-
FINAL
$
See Fee Schedule
TOTAL FEE
Dept.
Dept. of Bldgs. Phone SU. 4-7470
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 'k
Fridley,
correct.
�j Fridley, Minn / `�O �/ • 1946
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $ c9 0
7ZOl New. wilding Permit No. Permit No.
DESCRIPTION OF WORK
HEATING or POFMPLANTS--Ste Hot Wa , Warm Air— f
Trade Name- Size No Z/_ %
Capacity Sq. Ft. E.D.R.6-"BTU H.P.
/
Total Connected Load � Kind of Fu
BURNER — Trade Name Size No
Capacity.
(REMARKS -OVER)
4z 2M 7 -ss
Sq. Ft. E.D.R BTU H.P.
RAY N. WELTER HEATING CO.
Signer 4 H GAA
e WV
MINNEAPOLIS 7. MINNESOTA
By p
Business Phone No °�� �' 0 6 7
City of Fridley, Minn.
BUILDING PERMIT N° 6 716
Date: --��
Owner: �' Builder
Address
Address
LO TIO��DP�DING
No. Street _ (� Part t.
Lot _Block Addition or Sub- on
Corner Lot Inside Lot Setback Sideyard _
Sewer Elevation �� F dation Elevation
DESCRIPTION OF BUILDING
Front Depth Height / Sq. Ft. Cu. Ft
t Depth Leight z5� Sq. Ft. Cu. Ft.
Type of Constru , o Est. Cor 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
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ ____ , permit is hereby granted to
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota location, construction, alteration, maintenance, repair and moving of buildings
within the city limits permit may be revoked at any time upon vi of any of the provisions of said
ordinances. 11 A
NOTICE:
ibis permit does not sorer the construction, IesWWon for wirh& phmbin8, Bas heaft, sewer or water. Be sure to sec
the Budding hapestor for separate pennh for these fleas.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER ° S 17MV
�z,�e�.� �. IUU�.�z� BUILDER ---
ADDRESS -2 / a , ���zi� AI : ADDRESS
LOCATION OF BUILDING
No. /��/ Street C -i Part of Lot
Lot Block Addition or Subdivision_C -1 ae �i7
�,std�a
Corner Lot Inside Lot e- Setback Side Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates.
To be used as:
DESCRIPTION OF BUILDING
Front Z Depth Height_
Sq. Ft. S_ Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of ConstructionEstimated Cost
To be Completed
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE _ �STOM M,
(schedule of Fee Costs can be found on the Reverse Side).
susJEcr
PERMIT
City of Fridley
16 3�0
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
16
RE T NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
�
� �
f CITY HALL FRIDLEY 55432
,.j
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
I
I 8/2/82
JOB ADDRESS Overton Drive N. E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
24
5
Brookview Terrace 3rd SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Al Olson 831 Overton Drive N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Kenneth Welton 1148 - 101st Avenue N.W. 755-4762
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
geroof Dwellin
9 CHANGE OF USE FROM TO
STIPULATIONS
Roof can be 2nd but not 3rd roof. XNERN]C%XXX Install ridged galvanized
valleys.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
Asphalt
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
$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
SAC CHARGE
OVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$38.50
S U ION O HE PERFORMANCE OF CONSVfUCTION.
LAN CHECK FEE
TOTAL FEE
$39.61
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (VE)
WHEN PROPE VALIDATED THIS IS YOUR PERMIT
Y
BLDG INS DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE),
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATION! F014 RESIDENTIAL BUILDING PEWITS
(New, Alterations, Additions, or Repairs)
OTHER: (s f) V�-' BUILDER :�V�,'A� �- G- �►�
ADDRESS: _ �S ® y eve ADDRESS: %rlc,
TEL N0: TEL NO: '���
Construction Location
- STREET NO: ' 3 ( STREET:
IAT: BLOCK: ADDITION:
Corner Lot: Inside Lot: Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
Front:
DESCRIPTION OF CONSTRUCTION
Depth: Height:
4 Square Feet: Cubic Feet:
Front:
Depth: Height:
Square Feet: Cabic Feet:
Type of Construction: �_ = �r / �� Estimated Costa $ 222
To Be Cbrapleted: 8 /-/ / �; z --
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ ' $
SEE REVER.;E SIDE OF SHEET .
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do.all Work in strict accordance with the City of Fridley Ordinances and
rulings of the Deihartment of Buildings, and hereby declares that all the facts and
representations stated in this application a_re true and correct. If
DATE: Z- &- �—' SIGNATURE: ,
a=64 al��
Stipulations:
City of Fridley
AT THE TOP OF THE TWINS
SUBJECT
BUILDING
PERMIT
26748
r
• COMMUNITY DEVELOPMENT DIV.
� � PROTECTIVE INSPECTION SEC.
1 . I
CITY HALL FRIDLEY 55432
612-571-3450
Ufr
NUMBER
910415
REV
DATE
7/22/98
PAGE OF
APPROVED BY
JOB ADDRESS
831 Overton Drive
1 LEGAL
DESCR.
LOT NO.
24
BLOCK
5
TRACT OR ADDITION
1 Brookview Terrace 3rd
SEE ATTACHED
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Al Olson
571-5872
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
Viking Home Improvement 4832 NES72-IR20
4772
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
Reroof house and garage (25 Sq); Fascia
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with 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
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
ZONING
SO. FT.
CU. FT.
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
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER PECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
VALUATION
$2285
SURTAX
$1.14
DOES NOT PR ME TO GIV AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS F ANY OTHE TATE OR LOCAL LAW REGULATING COW
STRUCT N R THE PERFO ANCE OF CONSTRUCTION.
$74.75
Fire SC $2.28
PLAN CHECK FEE
TOTAL FEE
License SC $5.0,0
1 $83.17
SIGNATURE OF CO 'RACTOR OR AUTHORIZED AGENT (DATE)
WHEN PPRROPER
it/,
Bl G INSP
ALIDATED
THIS IS YOUR PERMIT
BATE
S,GNATURE OF OWNER IIF OWNER BUILDER) IDATEI
01
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 73 U2� f 3 h t 1rj V f w s -S%
�%
ft
Legal Description:
Owner Name & Address: I/ ®/so n /7 --re, Tel. #67 / - T )a
Contractor: -:7s�-IggmtkMN LICENSE # L}`7 2,
Address: �� (S ��1.2/ Tel. # ,O.
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�y� Sq. Ft.
OTHER:
2,' D o V9E – �S
Construction Type:
Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
DATE:
APPLICANT:
Tel. #S ->?2
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ /. (41
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$
�� 00
$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
$
83, 1 q
STIPULATIONS:
SUBJECT
City of Fridley
31701
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
R PT NO.
� 1 COMMUNITY DEVELOPMENT DIV.
r I PROTECTIVE INSPECTION SEC.
1 �
CITY HALL FRIOLEY 2%432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
91415
3/26/01
JOB ADDRESS 831 Overton Drive NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DEscR.
24
5
1 Brookview Terrace 3rd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Roger Kruse 831 Overton Drive NE
763-574-1293
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Sela Roofing & Remodeling Inc 4100 Excelsior Blvd, St Louis Park MN 55416
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
952-823-8046 1050
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW 0 ADDITION 0 ALTERATION REPAIR
0 MOVE O REMOVE
8 DESCRIBE WORK
Tuckpoint chimney
9 CHANGEOFUSEFROM TO
STIPULATIONS
Provide proper flashing on all exterior openings.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT
AUTHORIZED IS NOT COMMENCED WITHIN BO 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
$1,815
$.91
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC HARGE
PROVISIONS OF A O R STATE OR LOCAL LAW REGULATING CON-
OF P ORMANCE OF CONSTRUCTION
$66.20
F e SC $1.82
PLAN CHECK F
TO AL FEE
q6- ®'
Licen S $50$73.93
F CON"RACTORORAUTNORIZED AGENT IDATEI
EN P VALIDAT TH:3 YOUJIF PERMIT
8L NSP
OAf
$�GN4TURE OF OW NERi�i OWNER BUILDERi IDATEI
NEW I l Effective 1/1/2000
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: �3 31 ®V e c +o vl D y -
Legal Description:
-W S
Owner Name & Address: ) 6 0 c e- Ky"u S >� 5S I o vc r+on D r Tel. #_� i - 5— ?4/-
Contractor: MN LICENSE # 10 5-0
Address: SEI" � ROOFING & REMODELING, INC. Tel. # '3-0 tl�
ST. LOUIS PARK, MN 55416
MllWMAhis 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
OTHER:
Construction Type: l u f Po i h -r-r2 m nr►_i , ,1 Estimated Cost: $ f S
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$
DATE: 3 - 2 6- (D1 APPLICANT: 5 r- 14 90-04h ti Tel. # q6A--Dr2 3- 5 -OW
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee Fee Schedule on Reverse Side
Fire Surcharge $ 82 .001 of Permit Valuation (1/10th%)
State Surcharge $ g % $.50/$1,000 Valuation
SAC Charge $ $1100 per SAC Unit
License Surcharge $ &-06 $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 $ ')3,93
STIPULATIONS: �+
/ 40 1E
il�