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PRE 2010 DOCSCity of Fridley, . BUILDING IT N? 574 Date: _ f Owner: TWA Address.. LOTI®V OF BUILDING No. � Street,11141 .tf - P f Lot ?t Lot!!? _ .__ Block_ ._. _ Addition or Sub -Division 00, Corner Lot _ _ ______ Inside Lot _ _ Setback. Sideyard Sewer Elevation _ Foundation Elevation DESCRIPTION ®F BUILDING Tw V ;, I Front Depth Height Sq. Ft. � Cu. Ft. Wr Sq. Ft. � Cu. Ft. i�" ..._. o Depth Hei t .��..,,�a..aW , Type o Construction W, Est. Cost _ - _- To be Completed 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 all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ jL V'° , 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 viola ''on of any of the provisions of said ordinances. Building Inspector NOTICE: This permit does not corer the construction, installation for whug, "plumbing, gas heating, sewer or wafer. Be sure to we the Building lnspeetor for separate permits for these items. 4 APPLICATION FOR BUILDING PERMIT CITY OF P'RIDLEY, MIMNESOTA Address Z4A LOCATION OF BUILDING No.­Et g � Street :S NA V C- Part of Lot .� Block Ue els ® SCS Lot _ � .._....'�.._.-.... Addition or Subd�.vision, .� Corner Lot Inside Lot ✓'.S®tbackSrde-Yard SEVER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as Sq. Ft. Cu. Ft. Front �Depth A $ weight Sq. Ft. Cu. Ft. Type of Construction Estimated Cost �® To be Completed I ILL4 1, ) 1. The undersigned hereby makes application for herein specified, agreeing to do all work in the City of Fridley Ordinances and ruling of ings, and hereby declares that all the facts stated in, this application are true DATE Sg (Schedule of Fee Costs can be found a permit for the work strict accordance with the Department.of Build - and representations on the Reverse Side) . �• • � M i •'r W' J� APPhcation for Power Punts and Heating. Cooting. Ventilation. R&Mg9ration emd Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: Furnace Shell & Duct Work .......................... Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 .................. Repairs & Alterations each add. $500.00 ............... MECK. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ ,. each add. 60,000 BTU ....................... Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 ................. . Repairs & Alterations each add. $500.00 ............... STEAM or HOT WATER SYSTEM RATE TOTAL. 8.00 $ 5.00 $ 5.00 $ 2.50 $ 8.00 $ 2.00 $ _ 0.00 $ 5.00 $ 2.50 $ 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 S. /, So Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH -�FINAL See Fee Schedule �-— TOTAL FEE Dept. of Bldgs. Phone SII. 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 true and correct. Owner Kind of Fridlev. Minn zy�ZZ, - 19 4��2' Used as gl To be completed about Estimated Cost, $ A'6paa Old ew. uilding Permit No� Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS- Steam,of Wa , Warm Air—No- Trade Name , , �� Size No Capacity Sq. Ft. E.D.R -_:L: j BTU H.P. Total Connected Load .-I�f-� Kind of Fue BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) Signe 01 By d4L6a e� 4z 7M 7-59 Business Phone Application for Pourer 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 $P 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 $ r over 3 gal. per hour—See Fee Schedule ®r3 GAS BURNER (up to 400,000 BTU) ....................... 5.00 $�y 1 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 FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL See Fee Schedule TOTAL FEE 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 true and correct. Fridlev. Mann_ 19 Owner Kind of Used as To be completed about zo; e�- 60 Estimated Cost, $ 'o Old ew. uilding Permit No. Permit No. DESCRIPTION OF WORK ' HEATING or POWER PLANTS—Steam, of Wa , Warm Air—No- 000" Trade NameSize No Capaci Z7,049 Sq. Ft. E.D.R BTU H.P. Total Connected LoadKind of Fuel BURNER — Trade Name Size Capacity Sq. It. E.D.R BTU H.P. (REMARKS -OVER) 1 Signe L / 47 isinegn •... [NAME H T G ;C 0 N T R. ADDRESS FL. -3- ROOM LENGTH WIDTH HEIGHT WINDOWS -46 DOORS-CRACKAGE AND AREA NO. WIDTH I HEIGHT No. OF I LINEAL FT AREA LIGHTS OF CRACK SQ. F NT DATE NAME -0 P J O B [ADDRESS,. -TKA b " FL. ROOM LENGTH // WIDTH HEIGHTJ� WINDOWS AND DOORS-CRACKAGE AND AREA N0. WIDTH HEIGHT N0. OF LINEAL FT. AREA LIGHTS OF CRACK SQ. FT COEF.I BTU. II 1 1 1 1 1 1COEF.1 BTU. INFILTRATION 1® 6 COEF.1 BTU I I I I I COEF.1 BTU INFILTRATION GLASS INFILTRATION �d ° GLASS GLASS _ �� _ 9 GLASS NETEXP. WALL Zli EXP. WALL r - NET EXP. WALL?� EXP. WALL NET EXP. WALL NET EXP. WALL CEILING �� NET EXP. WALL °� CEILINGl ® CEILING CEILING Ile p/!° FLOOR TOTAL BTU. FLOOR �A FLOOR TO BTU. FLOOR TOTAL BTU. HEAT LOSS HEATING UNIT OTAL x,,,.,,� E.D.R. STEAM TOTAL SO. FT. H.W. TOTAL BTU. Cd VCS I TOTAL BTU.' TOTAL BTU.yr FL,. ROOM LENGTH WIDTH o �f® HEIGHT FL.� ROOMLENGTH � �J' WIDTH HEIGHT WIN,dOWS AN N0. WIDTH OORS-CRACKAGE AND AREA AREA HEIGHT LIGHTS OIF CRACK S0. FT. ® HEIGHT WINDOWS AND DOORS-CRACKAGE AND AREA NO. WIDFT.1 TH HEIGHT LIGHTS OF CRACK ISO. FT. ROOM COEF.I BTU. II 1 1 1 1 1 1COEF.1 BTU. INFILTRATION 1® 6 n r INFILTRATION JAIC GLASS GLASS GLASS �d ° GLASS _ �� _ 9 EXP. WALLEXP. NETEXP. WALL Zli WALL NET EXP. WALL?� CEILING NET EXP. WALL CEILING NET EXP. WALL °� CEILING CEILING TOTAL BTU. FLOOR _ TO BTU. FLOOR TOTAL BTU. HEAT LOSS HEATING UNIT OTAL x,,,.,,� E.D.R. STEAM TOTAL SO. FT. H.W. TOTAL BTU.yr o �f® TOTAL BTU. � �J' FL. �OM LENGTH �Si WIDTH ® HEIGHT FL. ROOM LENGTH 1,3 WIDTH HEIGHT WINEOWS AND DOORS-CRACKAGE AND AREA NO. WIDTH HEIGHT N0. OF LINEAL F LIGHTS OF CRAC ly ,--� ✓ e� �/6 e ddb .1,1' Q .� � AREA SQ. FT. � WINDOWS AND H N0. WIDTH g DOORS-CRACKAGE AND AREA HEIGHT NO. OF LINEAL FT. AREA LIGHTS OF CRACK SQ.FT. COEF.1 BTU. II 1 1 1 1 1 1 COEF.1 BTU. INFILTRATION n .INFILTRATION JAIC GLASS c GLASS EXP. WALL EXP. WALL All— l;NET NETEXP. WALL Zli NET EXP. WALL?� CEILING CEILING FLOOR FLOOR TOTAL BTU. TO BTU. �� TOTAL BTU. HEAT LOSS HEATING UNIT OTAL x,,,.,,� E.D.R. STEAM TOTAL SO. FT. H.W. rAME DATE NAME ' e�HTG. 'C 0 N T R. DDRESS �/' JOB [ADDRESS j.FL. ROOM LENGTH WIDTH Ij HEIGHTP FL. I ROOM LENGTH WIDTH HEIGHT WINDOWS AND DOORS-CRACKAGE AND AREA WINDOWS AND DOORS-CRACKAGE AND AREA NO. WIDTH HEIGHT No. OF LINEAL FT4 AREA NO. WIDTH HEIGHT NO. OF LINEAL FT. AREA LIGHTS OF CRACK SO. FT LIGHTS I OF CRACK SO. FT COEF. BTU. I COEF. BTU. INFILTRATION .INFILTRATION GLASS GLASS EXP. WALL EXP. WALL NET EXP. WALL NET EXP. WALL CEILING CEILING FLOOR FLOOR TOTAL BTU. TOTAL BTU. TOTAL BTU. HEAT LOSS TOTAL E.D.R. STEAM TOTAL SQ. FT. H.W. HEATING UNIT COEF.1 COEF.1 BTU I I I COEF.1 BTU INFILTRATIONAl" INFILTRATION GLASS ® �� ® GLASS EXP. WALL EXP. WALL NET EXP. WALL ® 'Il® NET EXP. WALL CEILING CEILING FLOOR FLOOR TOTAL BTU. ® TOTAL BTU. FL. ROOM OOM LENGTH sC WIDTH �� HEIGHT FL. ROOM LENGTH WIDTH HEIGHT ' WINDOWS AND DOORS-CRACKAGE AND AREA NO. WIDTH HEIGHT NO. OF I LINEAL FT.1 AREA LIGHTS OF CRACK SO. FT. ZI I Is WINDOWS AND NO. WIDTH WINDOWS AND N0. WIDTH DOORS-CRACKAGE AND AREA HEIGHT N0. OF LINEAL FT. AREA LIGHTS OF CRACK SO. FT. COEF. BTU. I COEF. BTU. INFILTRATION .INFILTRATION GLASS GLASS EXP. WALL EXP. WALL NET EXP. WALL NET EXP. WALL CEILING CEILING FLOOR FLOOR TOTAL BTU. TOTAL BTU. TOTAL BTU. HEAT LOSS TOTAL E.D.R. STEAM TOTAL SQ. FT. H.W. HEATING UNIT COEF.1 BTU. I I I I I COEF.1 BTU. INFILTRATION INFILTRATION GLASS ® ® GLASS EXP. WALL EXP. WALL NET EXP. WALL ® 6 NET EXP. WALL CEILING CEILING FLOOR FLOOR TOTAL BTU. ® TOTAL BTU. FL. ROOM LENGTH WIDTH HEIGHT FL. ROOM LENGTH WIDTH HEIGHT WINDOWS AND NO. WIDTH DOORS-CRACKAGE AND AREA HEIGHT NO. OF LINEAL FT. AREA LIGHTS OF CRACK SO. FT. WINDOWS AND DOORS•CRACKAGE AND AREA N0WIDTH . HEIGHT NO. OF LINEAL FT. AREA LIGHTS OF CRACK SO.FT. COEF. BTU. I COEF. BTU. INFILTRATION .INFILTRATION GLASS GLASS EXP. WALL EXP. WALL NET EXP. WALL NET EXP. WALL CEILING CEILING FLOOR FLOOR TOTAL BTU. TOTAL BTU. TOTAL BTU. HEAT LOSS TOTAL E.D.R. STEAM TOTAL SQ. FT. H.W. HEATING UNIT City of jr� PPl A ication for PlumbingCasFitting Renrpt DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $1.50 $ 3, sv Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTL) ...... Z x 2.00 $ OT New Ground Run Old Bldg . ............ x 3.25 $ Dept. of Bldgs. Phone SU 4-7470 �p Location SG nu. %z�G /s Ole,(� 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, ADnn JAPR 6 1962 . 19_ Owner / /- Z- C I -r i3 G '0 A .5 Kind of Building f2 Used as GGA To be completed about 6' -2- Estimated Cost, $ Old—New. Building Permit No 146-717 Permit No. q ®��. �4 PLUMBING CO. SignecY By —/— � ROUGH FINAL 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 $ �} v REPAIRS & ALTERATIONS—Refer to Code i Description ................................................$ TOTAL FEE $gfflo�.a 2 2M 7-59 Business Phone py. H w Z F t, N WATER HTR. GAS ELEG aa �O Base 1st 2nd f _ 3rd _ 4th • Future Connection Openings Connected withI Sewer � New .Fixture, Old Openings Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $1.50 $ 3, sv Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTL) ...... Z x 2.00 $ OT New Ground Run Old Bldg . ............ x 3.25 $ Dept. of Bldgs. Phone SU 4-7470 �p Location SG nu. %z�G /s Ole,(� 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, ADnn JAPR 6 1962 . 19_ Owner / /- Z- C I -r i3 G '0 A .5 Kind of Building f2 Used as GGA To be completed about 6' -2- Estimated Cost, $ Old—New. Building Permit No 146-717 Permit No. q ®��. �4 PLUMBING CO. SignecY By —/— � ROUGH FINAL 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 $ �} v REPAIRS & ALTERATIONS—Refer to Code i Description ................................................$ TOTAL FEE $gfflo�.a 2 2M 7-59 Business Phone CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Job Address Department of Buildings City of Fridley Tei. #571-3450 -- 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 Department of Buildings, and hereby declares that all the facts and representations stated -in this application aretrue and correct (� (% Fridley, Qmn. /-7—,7 - . 19 OWNER KIND OF BUILDINGUSED AS AS TO BE COMPLETED ABOUT PARTIAL RATE SCHEDULE H. ESTIMATED COST N ri PLUMBING FIXTURE RATES: NO. e RATE K 0 Fixtures Water o x $2.00 $ a y o $2.00 ,"q� an, w 7 $5.00 Heater 1-12 � Tel. No. l - y r $5.00 $ rn H ry U $ r, ua r $7.00 $ 6/ 1:ew Ground P„s Old Building x $5.00 .vi c ' o .oi u w ' Date = oc O ° u .Ci y G a m GAS FITTING FEES: U AJ U � Cl � Date 1st 3 fixtures u o [] $3.00 ts. -U q .t n: rd`�i _U $1.00 (d-- C7 O Gas Range to 199,000 BTU lec '- $10.00 ti REPAIRS $ ALTERATIONS N � 4. t1: $5.00 $2.00 $ $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 .e. $ .50 TOTAL FEE $ Is _ ! 2n3 3rd (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water Job Address Department of Buildings City of Fridley Tei. #571-3450 -- 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 Department of Buildings, and hereby declares that all the facts and representations stated -in this application aretrue and correct (� (% Fridley, Qmn. /-7—,7 - . 19 OWNER KIND OF BUILDINGUSED AS AS TO BE COMPLETED ABOUT PARTIAL RATE SCHEDULE ESTIMATED COST C� PLUMBING FIXTURE RATES: NO. RATE TOTAL OLD - NEW BUILDING PEPVIT NO. PERMIT NO. Fixtures Future FixtureOpening Fu x $2.00 $ Company C — New Fixture, Old Opening x $2.00 $ Signed By Catca Basin r. $5.00 $ 1-12 � Tel. No. l - Water Heater - to 99,G00 BTUx $5.00 $ 100,0-00 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ 1:ew Ground P„s Old Building x $5.00 $ ROUGH INSP. Date Electric :•rater Heater x $5.00 $ GAS FITTING FEES: FINAL INSP. f Date 1st 3 fixtures x $3.00 $ Additional Fixtures x $1.00 $�7 APPROVAL FOR PEP. -IIT - 7 q Gas Range to 199,000 BTU x $10.00 $ REPAIRS $ ALTERATIONS First $100.G0 each add. $100.00 or fraction $5.00 $2.00 $ $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 State Surcharge $ .50 TOTAL FEE $ REINSPECTION FEE ($30.00) SUBJECT PERS -r. City ®f Fridley 2 s 7 T PF THE TWINS BUILDING PERMIT RECEIPT 1 It® COMMUNITY DEVELOPMENT DIV. r C e PROTECTIVE INSPECTION SEC. e I 1 1e 1 i"""I CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY ' 612-571-3450 910-F15 12/28/98 JOB ADDRESS 5651 Regis Drive NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 18 2 1 Parkview Oaks First Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Caola Nguyen 574-9597 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Master Remodeling Inc. 32 10th Ave S Hopkins 55343 932-9311 20012916 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 MC REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house and ara e. 20 S 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 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 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 $1714 $.86 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 PLAN CHECK FEE Licens $5. ZALFEE 4.32 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI HE PRY VALI THIS IS YOUR PERMIT BL G INSP GATE SIGNATURE OF OWNER,IF OWNER BWLOERI IDATEI NEW [_.) Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: "feo 9G6'Y ® dY1 e , Legal Description: Owner Name & Address: C 4 01-/*_ /Ve' 51" e- Tel. # 57 ? V r 075?'? MASTER Contractor: 32 Tenth A�m South MN LICENSE # Address: HopkV%Mrak=% 55343 Of�4�� __11 Tel. # rwm �lam min 604 ication, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF Il"ROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: S621 Construction Type: 7exr- 6 v Estimated Cost: $ PLZ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft '= Ft x $ = $ DATE: Permit Fee Fire Surcharge State Surcharge SAC Charge APPLIC Tel. # ®/-�� License Surcharge $ Ss7 o o Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ (o cl 3Q STIPULATIONS: 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 [ ]