PRE 2010 DOCSa�
Community Development Department
P'LANNiNG DIVISION
City of Fridley
To: Files of Harstad Townhomes
FROM: --Michele McPherson, Planning Assistant
DATE: August 19, 1994
SUBJECT: Building`Permit Issuance
The Fridley City Council approved the attached site plan at its
August 15, 1994 meeting. In order for the development to proceed,
a rezoning was approved for the east half of the project site. At
the writing of this memo, the second reading of the rezoning
ordinance has not been conducted. The second reading and
subsequent publication will not occur until building permits.have
been issued for the building adjacent to Fillmore Street.
Building permits ale to be issued for building plans as indicated
on the enclosed"site plan. An increase.in the number of units will.
require review and approval by. the Fridley City'Councii. Any
decrease in density will be permitted; without review, by the City
Council.
Stipulated as a condition of the plat is that the petitioner is to
petition for construction of a cul-de-sac at the end of ;Polk Street
when building permits are applied for for 5531 and 5533 Polk
Street.
MM: ch
M-94-484
10
E
IN 16 P J -d — PI EIICFPT
a Y ..eYr R.. Wd h Y 1-1"
Planning Division
Official Copy
v� & COY 4' II&WA L,
VH AUl�JrwrK-,
• - A r• « (nal TII t 3
T7j(E ENGINEERING. INC.
7671 Centro] Av a NE Hiliwind - Townhomes
Fridley. UN 3U32 Utility Plan
(612) 783-0300
_ wa .n.n. Ate' T•�sD' 4 Fi
t
NOM
ANYANT
ATJIEITIE$ 810TH ON 1NG PUN
Im—" by
ARE ONLY APPR070YATE b DEPTH AND
tYat r.MW4 M eel 1 . rl
ANO NNSf BE VEURU BY
, T
11Y TY 6.1�
THIS C0N
CONTRACTOR. OT]HR IIlE1TR5
it IRwb sib Sb - W �
'a
TY lYM TIY ReI� c
.NAY
.MAY AND R STALL 111E
b33..11
.T
Im i.Y A.1 .wi —N
NSWI
RFODNSROTHE 01• .TIC CONTRACTOR
NT
•
TYY tW TYY y
TO WGOI RR IJCAToH OF SNaI
Fat ` eKam
Om t% / A— - —
IN 16 P J -d — PI EIICFPT
a Y ..eYr R.. Wd h Y 1-1"
Planning Division
Official Copy
v� & COY 4' II&WA L,
VH AUl�JrwrK-,
• - A r• « (nal TII t 3
T7j(E ENGINEERING. INC.
7671 Centro] Av a NE Hiliwind - Townhomes
Fridley. UN 3U32 Utility Plan
(612) 783-0300
_ wa .n.n. Ate' T•�sD' 4 Fi
SUBJECT
PER. -ALO.
City of Fridley
2 31 g
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
�•
RECEIPT/ NO.
`COMMUNITY DEVELOPMENT DIV
�: ------)
�O
r � PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
1Pp D10 94
CITY HALL FRIDLEY 55432
I.J 612-571-3450
910-F15
11/30/94
JOB ADDRESS 1055 South Fillmore Circle NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
13
1
Hillwind Townhomes SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Twin City Townhomes, Inc. 1250 E Moore Lake Dr, Fridley 55432 572-8872 8269
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
Cj NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Foundation for Townhouse and Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan. Paid Park Fee of $750.00. Variances approved on
8/15/94 to reduce the front yard setback from 35' to 30'; reduce setback from 25'
to 18.9' for front patios; and to increase the width of the driveways from 32' to
36'.
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
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 WHETH R SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$18,201.78
9.10
DOES NOT ESUME TO GIV UTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
Fire SC
PROVISIO OF ANY OTH T TE OR LO AL LAW REGULA ING ON-
STRU OR THE PERF CE OF STRUCOli
$198.00
800.00
PLAN CHECK FEE
TOTAL FEE
License SC $5.00
$1,030.30 + PF
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGEN IIIATE)
WHE/Npp�yPpROPE 1Y VALIDATED THIS IS YOUR PERMIT
- Btu G INSP DATE
S,GNATURE OF OWNER IiF OWNER BUILDER) IDATEI
NEW { ] Effective 1/1/94
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R -Z
Building Permit Application `f
Owner Name & Address: Tel. # S7 Z - 518 7
Contractor: -T w V e!' i / MN LICENSE
Address: / Tel. # S? Z -8912_
Attach to this application, a Certi4ate 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: lboo 4
Corner Lot { ] Inside Lot { ] Ft. Yd Setback Side Yazd Setbacks
Type of Construction: Estimated Cost: $ L _'v2 1i0.`6'16 f S 310 8y
Approx. Completion Date: L 46 c ! !.
(Cost on Back)'
Driveway Cut Yiclp Needed: Ft. + Ft = F — $
DATE: / APPLICANT: Tel. #��„�,�
cm Um ONLY
Permit Fee $ Fee Schedule on Reverse Side
Fire Surcharge $^ -20 ..001 of Permit Valuation (1/10th%)
State Surcharge $ l $.50/$i3O 00 Valuation
SAC Charge $ CC) $8W per SAC Unit
License Surcharge $ SQ $5.00 (State Licensed Residential Contractors)
Driveway. Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ r15 0 . oe, Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary ( 1
TOTAL $- rt z� �
STIPULATIONS:
SuBjECT
PE
City of FridleyF)
AT THE TOP OF THE TWINS
BUILDING PERMIT
Ir
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
L
r PROTECTIVE INSPECTION SEC
NUMBER
REV
DATE
PAGE OF
APPROVED By
1 CITY HALL FRIDLEY 55432
612-571-3450
910-F15
3/2/95
10B ADDRESS 1055 South Fillmore Circle NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
9
1
Hillwind Townhomes SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Twin City Townhomes Inc. 1250 East Moore Lake Dr, Fridley MN 55432 572-8872 8269
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
Townhouse & Garage FULL Permit
7 CLASS OF WORK
NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Full permit for 27' x 32' Townhouse and a 17'6" x 18' Garage. Foundation permit
issue 11/30/94.
9 CHANGE OF USE FROM TO
STIPULATIONS See notations on plan. Paid Park Fee of $750.00. Variances approved on
8/15/94 to reduce the front yard setback from 35' to 30' and to reduce setback from
25' to 18.9' for front patios and to increase the width of the driveways from 32' to
36'.
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
1 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
$72,799
$36.40
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NETO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE Fire SC
PROVIS ONS OF ANY OT STATE OR LOCAL LAW REGU TIN CON-
$401.00
PAID $72.80
STRIJCA19A OR THE P AN CONSTR ION.
PLAN CHECK FEE
TOTAL FEE
cc
�j
License SC $5.00
$515.20
SIGNATURE OF NTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROP Y VALIDATED THIS IS YOUR PE MIT
44
BLD INSP f1A
S,GNATURE OF OWNER of OWNER BUILDERi IDATEI
NEW
ADDN
ALTER
[ ] Effective 1/1/94
{ ] CITY OF FRIDLEY
[ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address:
....Legal Descriptioa: "_
Owner Name & Address:
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
%/, . Tel. # 7 7 2-
MN LICENSE # '��Z
Tel. # 577--J 3 -7
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length_ Width 52 � Height
Length 13K Widths ' Height
Length Width Hgt/Ground
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback
Type of Construction: IN
Approx. Completion Date:
63/ kO
Sq. Ft. (m vY, 7 Z
Sq. Ft. -3/5-_
Sq. Ft.
Side Yazd Setbacks
Estimated Cost: $ q/, 0, -73
( st on Bac )
Driveway Curb Cut Width Needed: Ft. 6 Ft -= — $
DATE: APPLICANT: Tel. #
r
�'; enc ;�'
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
d" A/
co
IAr7e
Sewer Main Charge
TOTAL
STIPULATIONS:
$ IVDA cfj
$ 12. P
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$$00 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 DIV. Effective On January 1, 1993
6431 Universjty Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
512-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS
BATE SCHEDIILE
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, Sumer — w rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace $ 20.00 $ represbntadons stated in this appfication are true and correct.
,1593
Gas Piping (Needed with new furnace) $10.00 $ 10,'
OWNER
Gas Range $10.00
BUILDING USED AS
Gas Dryer _ $10.00 $ r
ESTIMATED COST PERMIT NO. I�
*Air Conditioning —Aft Sizes $10,00 $ ! O
DESCRIPTION OF FURNAOE_AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work $ No, of Heating Units ) Circle One (Steam) (Hot Water)
Trade Name �Qd,� Size No.
Commerclalpndustrial BTUHP EDR
1% of Value of Appliance or Work $ Fuel %J�� ('r �s 3 Total Connected Load
State Surcharge $ .50 Sumer Trade Name Size No.
qtr BTU HP EDR-
TOTAL FEE
HEATING COMPANY
MINIMUM FEE FOR ANY HEATINGICOOUNGNENTILATION
REFRIGERATIONIAIR CONDITIONING PERMIT IS $15.00 jI I Signed By Tel No.
PLUS THE $.So STATE SURCHARGE i V
REINSPECTION FEE $30.00 Approved Rough—in Date Final Date 91S
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION
ON
REPLACEMENT FURNACE
CHIMNEY AND STACK '- RIFICATION
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
No
( )
size and total BTU's connected
Yes
(
)
6. Has total heating BTU's of
All other BTU's
TOTAL BTU's
Remarks
List~Alterations Being Done:
HEATING COMPANY
Signed By
Date
J
0
it
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
July 14, 1995
Twin City Townhouses Inc
1250 E Moore Lake Dr NE
Fridley, MN 55432
Re: Final Inspections at 1055 South Fillmore Circle NE and 1056 Fillmore Circle NE
Dear Sirs:
Final inspections were conducted on July 14, 1995 for the above noted addresses. We found that
the construction of the building units comply to the best of our knowledge and belief, with all
the requirements of the building codes of the City and the State of Minnesota relating thereto,
and permission is hereby given for the occupancy of said units.
If you have any questions on this matter, please feel free to contact me at 571-3450.
Sincerely,
f ILI M .
11 ARRY RIESCH
Building Inspector
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
572=3604
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES: NO
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
RATE. TOTAL
$ 7.00 17 CC
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$•7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$5.00
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1 % of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
JOB ADDRESS I V 1� h J � � 1 � ATy -Q Cs I � 01
The undersigned hereby makesapplication 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.
Owner 1 l V JV J 1/ "V�'r N -� G in -
Building Used As 1% U V -� L"\A
Estimated Cost
PERMIT NO, �;'//.
PLUMBING COMPANY
SIG.IJED BY 1�2" TEL N0.
Approved Rough—In Date Final Date
$ .50
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00
$ `LSL� PLUS THE $.50 STATE SURCHARGE
�'�Insetii>
a
Urinal :
.:...:..::.::
i
Sh 0
Shower ::� t1i�...
Wash..
Tray �pu:ritr:•.:
Floor
Dr
�.Auto.
:;tea: iitl������
Gas Water Heater
Washer `�:>':: Range � Gas Elec
Stories
Basem ent
F loor 1
-
Floor 2
Floor -3
a
-ME
Flo 4
Floor
PLUMBING FIXTURE RATES: NO
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
RATE. TOTAL
$ 7.00 17 CC
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$•7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$5.00
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1 % of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
JOB ADDRESS I V 1� h J � � 1 � ATy -Q Cs I � 01
The undersigned hereby makesapplication 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.
Owner 1 l V JV J 1/ "V�'r N -� G in -
Building Used As 1% U V -� L"\A
Estimated Cost
PERMIT NO, �;'//.
PLUMBING COMPANY
SIG.IJED BY 1�2" TEL N0.
Approved Rough—In Date Final Date
$ .50
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00
$ `LSL� PLUS THE $.50 STATE SURCHARGE
F,
01,
SUBJECT
PERMIT
City ®f Fridley
8792
r) THE TWINS
S67i-CUZ
BUILDING
PERMIT
E • COMMUNITY DEVELOPMENT DIV.
___ _
j - PROTECTIVE INSPECTION SEC.
000
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED Br
612-571-3450
910-F/5
12/31/98
JOB ADDRESS 1055 South Fillmore Circle NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DEscR.
13
1
Hillwind Townhomes
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
Top Gun Inc. 5014 Parrish Ave NE Rogers
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 MK REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside Townhome
9 CHANGEOFUSEFROM TO
STIPULATIONS
Call for building wrap inspection before covering.
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 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 RE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$500
$..50
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
$21.00
Fir SC $.50
PLAN CHECK FEE
TOTAYFAE
Lic SC
5 0
.00
SIGNATURE OF CON'RACTOR OR AUTHORIZED AGEN T IDATEI
NRLY
VA6LIgAjPrTHIS
IS YOUR PERMIT
A
11031
BLDG INSP
OAtE
S,GNATURE OF OWNER of OWNER BUILOERI IDATEI
01,
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
<—S �=-� I L�
Legal Description:
Owner Name & Address: Tel. #_
Contractor: 76'e J,�c MN LICENSE #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
GARAGE AREA: Length
DECK AREA: Length
OTHER:
DESCRIPTION OF IMPROVEMENT
Width
Height
Width
Height
Width
Hgt/Ground
Tel.#
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: 2 APPLICANT: Tel. #�"'-S��/
TOTAL $
a
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ 62/
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$
$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 $
a
STIPULATIONS: