PRE 2010 DOCS0
City of Fridley, Minn.
UILDING PERMIT4 s::7�O)
Date: ....1..__. .__"'y"'�._4'._ _..._«._......._..._..
.%........ :Qa: .d.. �s
Owner: ... ,fr Builder
�d. Jr
Address -•-----._...._ .....�" -_ , . Address
.....__......................_..........«.«.........«.«.««.«......_.-.-.-....._...«.......�.«....
. ................ ................ _............
�, LOCATION -SU1LDING
P�
No...747J Street _.Lt-'',,::`'._"^?`�" ............... PMI -Of Lot.
t................. Block �.
�` ---... Addition or Sub -Division
... `,,✓�, ���.�.� ,�cJ,�,�' _�.�r�,,.�:: �.,.d'
Lot ....._...._..._.............�,..........._...........
.....
Corner Lot .................................... Inside Lot ..... _...................... _.. Setback c.:...._............._ ........ Sideyard .1-,e....._ .-m-'s-11,
..._--' --�- .._......-.........
SewerElevation .....- ............................ .............. _............. -...... ....... .............. _........ Foundation Elevation ................................... _............ _............. ««............
DESCRIPTION OF BUILDING
Tore Used
J ,*
Front Depth Height Sq. Ft Cu. Ft.
1._..... ..,�"�-----?------- .. - .. e!:: , _ :
._ .I_- Fero � _ Depth ,....�r'... eeight ��� Sq. Ft. ���.s Cu. Ft..:.
Type o nstruction .r ? , . ..... Est. Cost 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 $.�!.: �..':.:............., 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.oftany of the provisions of said
ordinances.
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.
Owner's
Address
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
LOCATION OF BUILDING
No. Z/treet_�� dP r Part of Lot
Lot Block z Addition or Subdivision
Corner Lot Inside Lot Setback Side -Yard
SEWER ELEVATION FOUNDATION FMATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
To be used as:
DESCRIPTION OF BUILDING
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated 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 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. ,111 1
(A Schedule of Fee Costs can be found on the Reverse Side.)
HARVEY A. CARTWRIGHT
ANOKA COUNTY SURVEYS
HENNEPIN COUNTY SURVEYS
MINNEAPOLIS SURVEYS
8410 SHADY OAK LANE N.E.
SUNSET 0-0078
OWNER
INDUSTRIAL — JUDICIAL
BUSINESS — TOPOGRAPHICAL
CITY LOTS — PLATTING
Bud Nelson `R
t�
V I
CARTWRI& OLSON
LAND SURVEYORS
REGISTERED UNDER LAWS OF STATE OF MINNESOTA
LICENSED SY ORDINANCE OF CITY OF MINNEAPOLIS
345 PLYMOUTH BUILDING LINCOLN 6721
*mrbrpor'si Ctrtifitatr
COMBINING THE
RECORDS OF III
J. E. HILL. CIVIL
ENGINEER
:.4•
Al
[BTABLNN� 9888
�
1' i
C. F. SANDHOFF
A.9
CIVIL ENGINEER
e9TA10usroe0 IBOB
4
JAMES NELSON
Z
SURVEYOR
ESTABLIB,NED /Bga
METROPOLITAN LANDf
SURVEYORS. EB?ABLISHWO 1"I
Invoice 9711 5
1
I heraby certi_'y that this is a true and correct pl•t of a survey of
Lot 2, Block 1, Mississippi View, Anoka County, Minnesota, as surveyed
by r,rie this l6th day of Septer:ber, 1958.
SIGNED
k
AppIlication for Power Plants and Heating, Cooling. Ventilation..Refrigercttion 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 $
NECK. WARM AYR
Furnace Shell & Duct Work to 120,000 BTU ............
,r
each add. 60,000 BTU ... ..................
Replacement of Furnace ..............................
Repairs & Alterations—up to $500.00 ... ` ........... .
ftepairs & Alterations each add. $500.00 ....... :.......
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam, ......
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ...
Each add. 200 sq. ft. EDR Steam ......................
Each add. 320 sq. ft. EDR Hot Water ..................
g ®�"
8.00 $
2.00 $
§.00 $
5.00 $
2.50 $
8.00
$
8.00
$
2.50
$
2.50
$
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) .......................
5.00
$
GAS FITTING FEES:
NO RATE
TOTAL
1st 3 Fixtures ......................
x $1.50
$
Additional Fixtures .................
x .50
$
Gas Range to 200,000 BTU ...........
x 2.00
$
AIR CONDITIONING
$
FAN HEATING SYSTEM
See Fee Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
TOTAL FEE
$44r
-Q-4-
ROUGH
FINAL
Dept. of Bldgs. 7;,,pr, 4-7470
Location Zl 7 i -,,J 7/72 a
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.
11 Fridley, Minn- (" /dI A I`4 26 '190
Owner "D. r4 A a d e ea S ®rV
Kind of Building
Used as' s 0
To be completed about _
1I
Estimated Cost, $ "'E 5 C) N
-Okr New. Building Permit No Permit No. /
DESCRIPTION OF WORK
HEATING or POWER PLANTS --Steam, Hot Water, 4arm Air No
Trade Name C:°A 140 (G to k v - ®l� W ��Y�Size No._t a i ® ! U A C
Capacity Sq. Ft. E.D.R 10'010 O ® BTUH.P.
Total Connected Load 36.77 ®® Kind of Fuel L ° P- G A� C
BURNER —Trade Name . Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS—OVER)
By
4z 7M 7-59 Business Phone No- ��� q-3731
D•16 79 / e° o//®y, ice! s M11at
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS
Weatherstrips A.S.H.V.E, Construction No. Insulation
Guide
Windows Doors Reference Out. Wall Int. Wall I Ceiling I Roof I Floor Kind How. Applied
',:Yes4-No I e No 19— w, LT 3/4N
FlJ / , ,' , -, - Room i Lenath /.P Width /,2 Height P 11 I F1.1 P ®j Room l Length i a- Width f6 Height
Windows ang
Doors—Crackage and Area
jCoef.j
Btu
Width Height No. of Lineal ft. - Area
No. of pane of pane lights of crack —sq. ft.
a
l s yy�
2,3 (.
Glass4
Coef.
'50
00
Coef.
Btu
Infiltration
Glass
3
(�,
1
b �, O
Glass
�
Exp. wall
so
Sol
S O G
Exp. wall
(e{ q6
Floor
90
/p
I (® 0
Net exp. wall
7741o6
I F1.1 I?a-f.4
Room I Length P Width
/ G
Height P
Int. wall
,
C1 l
.7ff17
Ceiling
%
(�
Floor
1(�
-7
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl.l Room I Length O Width
Windows and Doors—Crackage and Area
Width Height No. of L1neal'ft. Area
No. of pane of pane lights of crack eq. ft.
12 Ir- q.�t- 133 1 ( 0
/Y I .?C1
Windows and Doors-Crackage and Area
jCoef.j
Btu
Infiltration
S
2,3 (.
Glass4
Coef.
'50
00
Exp. wall
/�O
"01
Glass
Net exp. wall
(�,
1
b �, O
Int. wall
�
Exp. wall
Net exp. wall
Ceiling
? O
2/3
(e{ q6
Floor
90
/® 1
I (® 0
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
7741o6
I F1.1 I?a-f.4
Room I Length P Width
L
Height P
Windows and Doors-Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
7
S
f U 6 r
Exp. wall
Coef.
Btu
Infiltration
q
3 ?
3 411
Glass
wall
56
9�-6 G
Exp. wall
176
'466
Exp. wall
Net exp. wall
Floor
16
2/3
Int. wall
✓
/® 1
Ceiling
/ aLo
q 6 6
Floor
I a.-6
7
336
Total Btu. I WOO,
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and Doors—Crackage and Area
Width Haight No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
";t- 30G 2 d
S
f U 6 r
Exp. wall
Coef.
Btu
Infiltration
G
39
? (- G
Glass
wall
50
('60
Exp. wall
176
'466
Exp. wall
Net exp. wall
Floor
/
Int. wall
✓
/® 1
Ceiling
/ aLo
q 6 6
Floor
I a.-6
7
Total Btu. I
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 &4 Room ( Length 1 O- Width )® Height 8
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
C)
Infiltration
1,2-16
Glass
S
f U 6 r
Exp. wall
Coef.
Btu
Net exp. wall
1b
{jInt.
wall
rZ.
Ceiling
'466
Exp. wall
C�
Floor
/
9,40
Total Btu. 6 7
Required sq. ft.-E.D.R. or sq. ins. W.A. Leader area
I F1.1 -P- I Room I Length I a Width P Heistlit
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef.
Btu
Infiltration
3
S'6
Glass
50
'466
Exp. wall
�, 4/
Net exp. wall
✓
/® 1
JS co
Int. wall
Ceiling
,
% G
Floor
%
Total Btu.
,equired sq. ft. E.D.R. or sq. ins. W.A. Leader area
,T0 , _ 30,700
5i.
Application for Power Plants and Healing, 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 .............................. 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. IDR 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) ............. I ......... 5.00 G
CAS FITTING FEES: NO RATE TOTAL
} 1st 3 Fixtures x $1.50 $ X, Z
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $�
ALTERATIONS & REPAIRS TOTAL FEE
ROUGH
FINAL
Dept. of Bldgs. Phone S
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application aretru and c �rorect.
A Fridley, Afro,. � / , 19 _
Owner
Kind of Building s
Used as
To be co
Estimated Cost, $ "-� • Q 6)
9kl---Permit No.
Building Permit No. -
DESCRIPTION OF WORK
HEATING or POWER PLANTS— steam, Hot Water, Warm Air—No
Trade Name Size No
Capacity Sq. Ft. EM.R BTU H.P.
Total Connected Load Kind of Fuel
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS—OVER)
Signe
By
?' p
.+ g 42 2M 7-59 Businfts Phone
City of Fridley
Application for Platnbing and Gas Fitting Permit
Dept. of Bldgs. Phone SU 4-7470
DESCRIPTION OF WORK
Number. Kind and Location of Fixtures
PARTIAL RATE
3
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures ......................
x
$1.50
$
Future Fixture Opening ................
w
Z
•
F
N
WATER HTR.
GAS
ELEC.
rn
x
3.25
I �
Water Heater (Up to 200,000 BTU) ......
x
3
o
New Ground Run Old Bldg. ............
4� 93
3.25
$
CAS FITTING FEES:
0
RATE TOTAL
1st 3 Fixtures ..........................
x
$1.50
Base
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
1st
2nd
3rd
4th
• Future Connection Openings
Connected with
New Fixture, Old Openings
I
Sewer �
Cesspool
PARTIAL RATE
SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures ......................
x
$1.50
$
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
$
New Ground Run Old Bldg. ............
x
3.25
$
CAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
x
$1.50
$44T
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
REPAIRS & ALTERATIONS—Refer to Code
f
City of Fridley:
<
A/d
r
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 01 as 1961
Owner 19—
Kind of Building
Used as
To be completed about
Estimated Cost, $ e�
Q14 --New. Building Permit
Description................................................$
TOTALFEE ,�, E, $ 11 POST IM -12-58
19—
0
A
CITY OF FRIDLEY
Effective May 1, 1990
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
RESIDENTIAL I RATE TOTAL Job Address
Furnace Shell and Duct Work,
Burner (Also replacement furnace) $ 20.00 $G' Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
City of Fridley
Gas Piping $ 10.00 $ %(/+ Tel. 0571-3450
(piping needed with now furnace)
Gas Range $ 10.00 $ 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
Gas Dryer $ 14.00 $ and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
• Air Conditioning (all sizes) $ 10.00 $ Fridley, Minn. -7—
All Others/Repairs and Alterations OWNER (C
10 of Value of Appliance or Work S
KIND OF BUILDING
COMMERCIAL/INDUSTRIAL USED AS
1• of Value of Appliance or Work $ TO BE COMPLETED ABOUT ` ` q— �,e
ESTI TED COST
State Surcharge $ .50 !
OLD NEW BUILDING PERMIT NO. PERMIT NO. ( _
TOTAL FEE $
Reinspection Fee ($15.00) $ �,�
G�I"d DESCRIPTION OF FURNACE/BURNER
Rough Inep. HEA ING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Date/ t
Final Insp. �L` ' ade Name Zx< �'+V� Size No. -S-6466,0
Date ( Capacity Sq. Ft. EDR BTU HP
Approval for Permit
PP Total Connected Load � � �$ t� Kind of Fuel /%/ A /
�v
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00 Company S% X -i3
PLUS $.50 STATE SURCHARGE
Signed ey
Te 1. No.
*Air Conditioners can not be placed in side yard without
written permission from adjoinitig m!ig1 bor.
Fill out back side for stack verification on replacement furnaces
CHIM14EY 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 ( )
5.
Meets all -current Code requirements for.size and
total BTU connected
Yes ( )
No ( )
6.
Has Total heating BTUts of
All other BTU's
TOTAL
Rema rk s
Company
Signed By
Da to
Rok�-z;�CIc'k %U nje L
71 7,S-- °T lege
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1.
Has been carefully examined
Yes j
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
total BTU connected
requirements for size and
Yes*
es
No ( )
6.
Has Total heating BTU's
of
All other BTU's
1
TOTAL
Rema rk s
STANDARD HEATING AND AIR CONDITIONING
Company _ 410 WEST LAKE STREET
MINNEAPOLIS, MN 55408
Signed By L PHONE 824-2656
Da to
G 14/1 �
•
SUBJECT --
.-City
of Fridley
7�9% 6 2
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
------.
L?3J
PROTECTIVE INSPECTION SEC.
,3
NUMBER
REv
DATE
PAGE OF
APPROVED BY
;•j CITY HALL FRIDLEY 55432
L f\ 612-571-3450
910415
6/24/99
JOB ADDRESS 7175 Riverview Terrace
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
1 Mississippi View
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Rod Nagle
371-6361
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Precision Roofing 200 W 88th St Ste 4 Bloomington 55420 884-4044 20141220
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 Ex REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (26 Sq) Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
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 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
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
2272
$1.14
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
$83.25
Fire SC $2.27
PLAN CHECK FEE
TOTAL FEE
License SC
$5.0,Q
$91.66
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERL
EISAr".NSP
ALIDATED THIS IS V IURMIT
OAtE
S,GNATURE OV OWNEAoF OWNER BUILDER, IDATEt
01
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: "71`11r=��-
Legal Description:
Owner Name & Address:
Contract
Address
Tel. # 93�A--eez-5a='I
TENSE # � j!4AZ2%:>
Tel. #�'`'
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it Ito 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:
25.33 10duAMWS
Construction Type:V: Estimated Cost: $ S12207
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
= $ c2c7, %,;7
DATE:44;;;�"- APPLICANT: - Tel. #' ' j
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
r'a, Fee
STIPULATIONS:
$ 93, c25
$ j • le? 7
$.Z=/ - 6 6
300
�7—(. 66
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
r