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PRE 2010 DOCSSUBJECT IT NO. 72 City of Fridley 718 AT THE TOP OF THE TWINS BUILDING PERMIT REC -----_ COMMUNITY DEVELOPMENT DIV. 73- r i � PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 IL" %J NUMBER REV. DATE PAGE OF APPROVED BY --A, 612-571-345.0 910-F15 1/26/93 JOB ADDRESS 1165 Regis. Lane NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 Sullivan's Overlook SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Classic Home Design 1630 Hwy 10 NE, Spring Lake Park, MN 55432 783-9866 5867 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 [J NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 471 x 20 Dwelling and a 32 ` x 22' Garage SEPARATE PERMIT'S RE UIRED FOR 9 CHANGEOFUSEFROM WIRING, T EATING, PLUMBING AND SIGNS, STIPULATIONS provide a hard surface driveway. Provide sod in the front and side yards. Provide City with copy of verifying survey before capping. Curb cut subject to Spring bids - they are expected to remain the same, See notations on plan. Paid $750..00 Park Fee and $351.00 Driveway Curb Cut (261 x $13.50). SEWER LOCATION: 681 W of M.H. (W. Inv. 953,19) WYE ELEVATION: 950.18 W/31 Riser. TOP OF FOOTING: 953.18 Minimum WATER LOCATION: 101 E of Sewer Service WARNING Before digging call for all utility locations THE CITY OF FRIDLEY DOES NOT GUARANTEE THE ACCURACY OF UTILITY L;?C'A'T101',;S AND ELEVATIONS. 454-0002 DATA IS FOR IN1=i1�;r A i ECi-ki PURPOSES ONLY, REWIRED �Y LAW AND PERSONS USING; THIS IINFO MAT10N SHOULD VERIFY IT ON THE SITE. 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 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 VALUATION SURTAX Fire SC AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $45.48 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $90,959 $90,96 PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $599.00 $750.00 STRUCTION OR THE PERFORMANCE OF CONS RUCTION. PLAN CHECK FEE TOTALFEE &'_ License SC $5.00 $1490.44 + PF & DW SIGNATURE OF CONT RACTOR OR AUTHORIZED AGENT (DATE) HEN OP Y V L AT THIS IS YOUR PERMIT LDG WSp GATE SiGNATURE OF OWNER OF OWNER BUILDERI IDATEI NEW [ ] Effective 1 / 1 /93 ADDN [ ] CITY OF FRIDLEY ALTER[ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Legal Description: Owner Name & Address: Cz'd, c 1--lol-ii OjE� A) Tel. # 2;?S - ZFC-C Contractor: ��I�E MN LICENSE # ©( C),r,- G Address: /6 -?o 4L/v) Tel. # AttAch to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT . F( ' LIVING AREA: Length -1-.`-- Width --Height g Sq. Ft. GARAGE AREA: Length Width d,) ' Height _ i Sq. Ft. DECK AREA: Length---- Width Hgt/Ground Sq. Ft. OTHER: Comer Lot [ ] Inside Lot (] Ft.. Yd Setback Type of Construction: \�j o ©dD Approx. Completion Date: _ Side Yard Setbacks Estimated Cost: $ q/ O, 9 s-9 Driveway Curb Cut Width Needed: X20 Ft. + 6 Ft Ft x $ (Cost on Back) - /3.S271 = $ .� DATE: % - -� APPLICANT: �� Tel. CITY USE ONLY Permit Fee $ 400 Fee Schedule on Reverse Side Fire Surcharge .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ 'SS>06 $750 per SAC Unit License Surcharge $ Z: 00 $5.00 (State Licensed Residential Contractors}' p a 13a Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $�y Fee Determined by Engineering Sewer Main Charge $_ r er Agreement Necessary [ ] Not Necessary ( ] TOTAL STIPULATIONS: PA44-4 '044 �J CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Stories Basement Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: Effective On January 1, 1993 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Urinal ........ I�TtiI'>'. Shower1.*'..-*'..-*.';��t'`� ... Wash Tra v <>µi��a�>I. Floor a Dr in �i����r e Wash r �'���< `#�r��t ..... GassA a Ran NO. RATE TOTAL JOB ADDRESS I&f New Fixtures _ Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater —Electric Water Heater — Gas Gas Range Gas Dryer Back Flow Preventer Required ( )Yes () No. Type Water Heater Gas 1 lee $ 7.00 The undersigned hereby makes application for a permit for the work herein $ 4:00 specified agreeing to do all work in strict accordance with the city codes $ 5.00 and rulings of the Building Division, and hereby declares that all the facts $ 7.00 and representations stated in this application are true and correct. $ 7.00 $ 7.00 , 1993 $ 7.00 %� / j $10.00 Owner C _l4ssle dz;p[ 'V $ 7.00 $10.00 Building Used As $10.00 $10.00 Estimated Cost PERMIT NO. $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance 1; `f State Surcharge $ .50 TOTAL FEE $qq! PLUMBING COMPANYd�! SIGNED BY TEL NO.Lk Approved By Rough—In Date Final Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1993 6431 University Ave NE Fridley, MN 5,5432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 672-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADORES S-'�CZ RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner - rulings of the Building Division, and hereby declares that all the facts and Also Replacement Fumace $ 20.00 $ representations stated in this application are true and correct. Gas Piping (Needed with new furnace) $10.00 $J°�- ,1993 _ a /� Al Gas Range $10.00 $ BUILDING USED AS Gas Dryer $ 10,00 $ /®•�" ESTIMATED COST „� � t, �' PERMIT NO. -%/�� *Air Conditioning - All Sizes $10.00 $ All Others/Repairs•& Alterations (LIST ON BACK) DESCRIPTION,OF FURNACE AND OR BURNER 1% of Value of Appliance or Work $ No. of Heating Units_ Circle One (Steam) (Hot Water)arm Al Trade Name ��� Size No. fd°7�4 el® Commercial/Industrial BTU EDR ' 1% of Value of Appliance or Work $ Fuel s ® Total Connected Load 0.e State Surcharge $ .50 TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATIONIAIR CONDITIONING PERMIT IS�15 00 PLUS THE $ So STATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed In a side yard without written permission from adjoining property owner. Burner Trade Name Size No. BTU HP EDR HEATING COMPANY_St Signed Ci Approved ByRough-In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: I. Has been carefully examined 2. Is free from rust or deterioration 3. Has no foreign objects lodged within 4. Is securely supported Yes No ( i 5. Meets all current Code requirements for size and total BTU's connected Yes No ( i 6. Has total heating BTU's of 7 co All other BTU's qLA ao L) TOTAL BTU's 10, Remarks List Alterations Being Done: HEATING COMPANY Signed By Date MEMORANDUM TO: Steve Barg, Code Enforcement PW93-331 FROM: Scott Erickson, Asst Public Works Director DATE: August 31, 1993 SUBJECT: 1165 Regis Lane - Erosion On August 30, 1993 1 performed a field inspection of the reported erosion problem occurring at 1165 Regis Lane. The address is the site of a newly constructed residential home. Erosion is occurring along the back of the property as the lot drains toward the back. The erosion is occurring due to the fact that the yard has not been seeded or sodded. Sodding of the yard, both front and back, should greatly improve the situation. If they choose to seed the yard, they will need to install erosion control blankets and additional silt fencing around the entire site. If you require any additional information regarding the site erosion on this property, let me know. SE: cz AN] ci cmrOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 • FAX (612) 571-1287 September 28, 1993 Classic Home Design 1630 Hwy 10 NE Spring Lake Park MN 55432 Re: Final Inspection at 1165 Regis Lane NE, Fridley Dear Sirs: A final inspection was conducted on September 28, 1992 and the following item was noted which must be completed before the structure can be finaled: Provide sod in the front and side yards by June 15, 1994. We will expect this item to be completed on or before the scheduled date and a reinspection called for. If you have any questions on this matter, please feel free to contact meat 572-3602. Sincerely, i THOMAS BLAkINAj chief Buildi Official TB/mh O G7YOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 • FAX (612) 571-1287 April 15, 1994 Classic Home Design 1630 Highway 10 N.E. Spring Lake Park, MN 55432 RE: Property at 1165 Regis Lane N.E. Dear Owner/Manager: On January 26, 1993, you obtained Building Permit No. 21718 to construct a new residence and garage at the above referenced location. One stipulation of this permit (copy enclosed) required that sod be provided in the front and side yards of this property. On September 28, 1993, former Chief Building Official, Thomas Blazina, sent you a letter (copy enclosed) once again advising you of this and requiring that this problem be corrected by June 15, 1994. I will reinspect this property on or before June 15, 1994, at which time full compliance is expected. 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 cc: Timothy and Karen Coleman 1165 Regis Lane N.E. Fridley, MN 55432 CE-94- SUBJECT City of Fridley23115 AT THE TOP OF THE TWINS BUILDING PERM IT(PERMIT PT NO. Ir ____ COMMUNITY DEVELOPMENT DIV. r 1 L a_ PROTECTIVE INSPECTION SEC I �f 1 7 ® 7 � NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 11/23/94 JOB ADDRESS 1165 Regis Lane NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 1 Sullivan's Overlook SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Timothy Coleman 1165 Regis Lane NE 572-2064 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 O NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE x 8 DESCRIBE WORK Construct a 12' x 20' Deck in Rear Yard 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. WARNING Before digging calf for all utility locations 454.0002 REQUIRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. 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 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 $1,956 .98 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- Fire SC $1.96 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $45.00 PLAN CHECK FEE TOTALFEE $47.94 SI�NATUREOFNTRACT OR R AUTHORIZED AGENT IDATEI WHEN PROPS Y VALIDATED THIS IS YOUR PERMIT B G INSP MATE SIGNATUR41."N1 R IIF OWNER BUIL DERI (DATE) NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: Legal Description: Owner Name & Address: � � ? _ /,��,,�,�,,,� Tel. #5Z2 -aG 6�_ 4 Contractor: �" i ,�_ MN LICENSE # Effective 1/1/94 4 4V-,797 Address: LIVING AREA: GARAGE AREA: �( DECK AREA: OTHER: Tel. #, Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IWROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width ;7- O '` Hgt/Ground /g ` Sq. Ft. Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Dee-- Estimated Cost: $ 1?00. a Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ — $ Y DATE: 1-21-gy APPLICANT: Tel. # Al- 5-7/ - 3 2-0-0 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL I STIPULATIONS: $ P,' Fee Schedule on Reverse Side $ q� ..001 of permit Valuation (1/10th%) $ qW $.50/$1,000 Valuation $ $8M 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 [ ] r 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, 572-3304 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS_ , A)&' HATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes ar _i Furnace Shell and Duct Work, Burner — rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 30.00 $ representations stated in this application are true and correct. (Side Vent — Fill Out Back) ®C' a-Lp 11995 Gas Piping (Needed with new furnace) $ 10.00 $ OWNER Gas Range $ 10.00 $ �r BUILDING USED AS S-LhAl Gas Cryer $10.00 $ ESTIMATED COST 6 PERMIT NO. *Air Conditioning —All Sizes $ 25.00 $ DESCRIPTION OF FURNACE AND OR BURNER 1 Others%Repairs & Alterations (LIST ON BACK) 9"3" 1% of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. Commercial/Industrial BTU HP EDR 1.250/c of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge $--50 Burner Trade Name Size No. • TAL FEE_ BTU HP EDR BLAINE HTG. AIC & ELECT. INC. 13M CENTRAL AVE. M.E. HEATING COMPANY MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIt-ERATION/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. Tel No. FILL OUT BACK SIDE -POR STACK VERIFICATION ON REPLACEMENT FURNACE Final Date Remarks: List ALTERATIONS Being Done: &M�4jzl _ )N, AJA e / (3) 131 n ) iAiA HEATING CO: Signed By: Date: CHIMNEY AND STACK VERIFICATION The undersigned hereby_ verifies that the existing chimney or stack: I. Has been card + examined Yes ( ) No ( ) Z. Is free from rr deterioration Yes ( ) No ( ) 3. Has na, . greig ects lodged within Yes () No .( ) 4. } Is securely supl�rted Yes (} No ( ) 5. Meets 'all current Code requirements for size and, Otai BTU's connected Yes( ) No ( ) 6 Has to taf&ating BTU's of All rather BTU's TO-fA'—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: &M�4jzl _ )N, AJA e / (3) 131 n ) iAiA HEATING CO: Signed By: Date: SUBJECT(Af-RMITNO, of Fridley 7city 9 AT THE TOP OF THE TWINS BUILDING PERMIT r • _ COMMUNITY DEVELOPMENT DIV. i fr --- - r � PROTECTIVE INSPECTION SEC. 5 c- C � auMBEA nEv DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 1 763-571-3450 910-F15 6/10/03 JOB ADDRESS 1165 Regis Lane NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 Sullivan's Overlook SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tim Coleman 1165 Regis Lane NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Richard Hastings Contractor 6331 Riverview Terrace NE, Fridley, MN 55432 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 763-574-9966 4051 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION Lj REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (23 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 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 @ $2,663 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1.33 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $83.25 FireAC $2.66 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION e00, PLAN CHECK FEE TOTA EE �^ � /0 O Licens $5,,PO/ $ 2.24 SIGNATURE OF CONTRACTOR OR AUT RIZED AGENT TDATE, N P OP ,. ALIDAT HIS IS Ver UR R IT iNSP riAtz S,GNATURE OF OWNER OF OWNER BUROER� iDATEi NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 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: 9 11 - Legal Legal Description: Owner Name & Address: Co GXAAAAI Tel. # Contractor. 'R� c.4 A' F -b A -,+, 41 C S MN LICENSE # ®� J Address: 6 3a I R", V,01Z 0 a`EL-3 EE E . Tel. # 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. OTHER: �� S Construction Type 7 -C - A R OFF 4-Rf1zu0F. Estimated Cost: $ C; 6 ` Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$ DATE: ® Zo APPLICANTS Z 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. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Inw�16 $ ZJ S Fee Schedule on Reverse Side $ 4 6 .001 of Permit Valuation (1/10th%) $ la 3 3 $.50/$1,000 Valuation $ --�'�~ $1275 per SAC Unit $� gg- $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 [ ] $ .per STIPULATIONS-