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PRE 2010 DOCSr City of Fridley AT THR TOP Of THE TWIN$ rL-------- COMMUNITY DEVELOPMENT DIV, 1 1 morgCTIVE vieftCTIpp an, ---` ; CITY HALL PPAMv EMR 44-400-34" 3 53-8k—s-915.51 MOIJECT PLUMBING PERMIT APPLICATION 6361 N. E. Squire Drive Owner Address Phone Rattlund Company 561-4340 Contractor Address Phone MIM EGASCO 733 MARQUETTE AVENUE Kind of Building Use 'MP- Frame Res. =estimate Cost *. 2-7-75 10.00 tion /9-77-25 — Plumbing Fixture Rates: N0. I! RATE TOTAL Number Fixtures i i '781N'X i $1.50 New Fixture -Old Open. x •eao�l Catch Bastn x $3.25 Water Heater -99,000 BTU x $3.00 f! •Mwva n I I $2.00 Gas Fitting Fees: 1st 3 Fixtures x $2.00 Additional Fixtures--� it $ .75 Gas Range -199,000 BTU m y, BNtBV9 I! "7ddVl I i I I O /9-77-25 — Plumbing Fixture Rates: N0. I! RATE TOTAL Number Fixtures i i '781N'X x $1.50 New Fixture -Old Open. x •eao�l Catch Bastn x $3.25 Water Heater -99,000 BTU x $3.00 f! •Mwva $3.25 I I $2.00 Gas Fitting Fees: 1st 3 Fixtures x $2.00 Additional Fixtures--� it $ .75 Gas Range -199,000 BTU m y, BNtBV9 I! w (tQi3 iNlVagl C I ( I I 3 O aoo�� 'Oa O Pt ttlio i l sa3M011S1 I I 1N0od I I >1 Iaq Nto � 8AVlIlI ,r A NBVM I I I I' MINISI I I I I iNIBvaI I I I ions I I N1VB InvNlanl I I I I f i13Ho•no apAv�a /9-77-25 — Plumbing Fixture Rates: N0. RATE TOTAL Number Fixtures x $2.00_ Future Fixtures x $1.50 New Fixture -Old Open. x $1.50 Catch Bastn x $3.25 Water Heater -99,000 BTU x $3.00 Ground Run Old Bldg. x $3.25 Elec. Water Heater x $2.00 Gas Fitting Fees: 1st 3 Fixtures x $2.00 Additional Fixtures--� x $ .75 Gas Range -199,000 BTU x $5.00 i Repairs & Alterations Install D See Description. ryer Code 5•oo State Surcharge Cess �rchseg 00 .50 TOTAL FEE $ 5.50 !The undersigned hereby makes application for a permit for the work herein specifiedv agreeing to do all work in strict accordance with, the City Ordinances and ruling of the Department of Buildings, and hereby declare that all'the facts and representations stated in this application are true and correct. 'Signature Date Main Office 784-6066 U13URBAN 6875 Highway No. 65 N. E. ' a Pd01NrmF-R11MG Minneapolis, Minnesota 55`432 INC South Office 890-6510 w Civil, Municipal & Environmental Engineering 110.1 Cliff Road Land Surveying • Land Planning • Soil Testing Burnsville, Minnesota 55337 Li City of Fridley 6431 University Avenue N.E. Fridley, Minnesota 55432 Attention: Mr. Darrel Clark Dear Darrel: October 8, 1974 Re: Harris Lake Estates We have recently provided excavation inspection and compaction testing on lots 15 and 16 of block 2 in the above captioned subdivision. The previously placed granular fill material was removed and the organic topsoil excavated. Several hand holes drilled in the bottom of the excavation showed granular material to a depth of approximately four (4) feet, the length of the auger. A compacted granular pad was constructed as per our letter dated April 26, 1974. Density tests showed lot 15 to be 92% of modified proctor density and lot 16 to be 90% of modified proctor density. ' - If you have any questions or we can be of further assistance, kindly call at your convenience. PJM/rp gid o Sincerely, SUBURBAN ENGINEERING, INC. Peter J. Molinaro CLO Zt-'441, coo Robert blinder, Reg. Eng. E. A. Rathbun, Reg. Surv. Charles L. Lenthe, Reg. Eng. John F. Dwyer, Reg. Suru. Jeffrey J. Roos, Reg. Eng. Wm. E. Jensen, Reg. Eng. Wm. K. Meyer, Reg. Eng. Wm. E. Price, Reg. Eng, Donald E. Wadleigh, Reg. Eng. SUBJECT4(D7;� 0. City of Fridley '76'7 AT THE TOP OF THE TWINS BUILDING PERMIT r REC COMMUNITY DEVELOPMENT DIV./ee INSPECTION r PROTECTIVE SEC. 1 . � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 10 16 74 JOB ADDRESS 6361 Squire Drive N.E. 1 LEGAL LOT NO. BLOCK TRA CT OR ADDITION SEE ATTACHED DESCR. 16 2 Harris Lake Estates SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Rottlund Company, Inc. 1581 Rice Creek Road N.E., Fridley 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LI ENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. -F-ENGINEER MAILADDRESS ZIP PHONE LIQENSENO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 26' x 40' Dwelling and a 26' x 24' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before capping. SEWER LOCATION: 178' N.W. of Manhole (N. Inv. 878.31) Wye Elevation: 879.20 Top of Footing: 884.20 Minimum WATER LOCATION: 10' N.W. of Sewer Service SEPERATE PERMIT'S REQUIRED FOR MIRING, HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR-CONDITIONING. Wood Frame 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 R-1 1130 27,040 Total 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. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $26,139 13.07 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- ST U TION E PERYORMA CE OF CONSTRUCTION. $51.00 $300.00 PLAN CHECK FEE TOTAL FEE fP..� ®� � tt /(:) --16 �- 7 $364.07 a R-14 ATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) W N PROPERLY VALIDA HIS IS YOUR PERMIT BLDG INSP DATE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE') APPLICATION FOR RESIDENTIAL, ALTERATION, 0 OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME • ' BUILDER :-7�P �1S a y 1 c -- Z ADDRESS: ADDRESS : �_�� �� e NO:.O Co/ STREET: --,2 �zu r `✓ -P A(/ LOT: /,/,' BLOCK: 2 ADDITION: z� s e9% QS' 7�s j -e S CORNER LOT: INSIDE LOT: X SETBACK: 3 5 SIDEYARD:/2 Applicant attach to this form Two Certificates -of Su2vey.of Lot and proposed building location, drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: Front : Depth: &/® Height: f �- Square Feet: 413 0 Cubic Feet: 44 Front: 2 Depth:. 2- c/ Height: s6) - Square Feet; Cubic Feet: Type of Construction: F,¢��,-e Estimated Cost:1?9" © o v 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: /O SIGNATURE: (See Reverse Side For Additional Information.)N ` r MAT1, S 011M' ` yff101, 6875 Highway No,65 NJ. Land Planning Rand Surveying1 r • 1 • �� Minneapolis Soils Testing l!• � :� . Minn. $5432 Civil Engineering Telephone 784=6066 MunicipoI Ingineering Engineers & Surveyors Area Code 613 20TTLL)W D t 0- Certificate of Survey for o BLOCK Hm LM Emaq Anka eouiliq I hereby certify that this is a true and correct representation M a survey Of, the boundaries- of the above described land, and of the location of KJI buitdings thereon, and alt vi ibie encroachments, if any, from or on said � tend. As surveyed by me thiswday of� A.D. 19. c DEWT6 IRON .MOWMT SUBURBAN ENGINEERING, INC. • 13ngirreers Surveyors -�--- Ms G( 1N GSC UT TY' W£MENT by 1 i a p tev n Cc M Com. 4j P !i! o � � U h�� 'O M m m m M O N cr, C6 QO N rTTt Oi I ga Oi I City of Fridley fW r1z:�Ing MCI G7= Dmpt. of Bldg*. Phone 580 -3450'c - DESCRIPTION of wonx Lem 6 361 Number, Kind and Locaiien of Fixtures -p---- City of Fridley: The .undersigned hereby makes application for a permit for the work here! specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are rue and correct • nn1972 Owner Kind of Building) �•ii i l /l Qused as To be completed about PARTIAL RATE SCHEDULE Estimated Cost, $ PLUMBING FIXTURE RATES: NO. RATE TOTAL Old—New. Building Permit No. Pormit Ido. ���� Number Fixtures ............:.... x $2.00 $®' Future Fixture Opening ........... .3 x $1.50 $ q__ New Fixture Old Opening .....:.... - x $1.50 $,.__ Catch Basin ..................... x $3.25 $ Water Heater (Up to 99,000 BTU) .... x $3.00 $ 3• v D • New Ground Run Old Bldg......... x $3.25 $ ROUGH - Electric 9i/atar H"ter.............. : $2.00 $ ZAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures Z x $2.00 g J ®y Additional Fixtures .................. x $ .76 $ Gas Range to 199,000 BTU ... ,.......... x $5.00 6 sv REPAIRS ALTERATIONS --Refer to Coda, .50 State Surcharge .Description ...`� ........... , ............................ TOTAL A'EE 3 �tii ert j Signed Business No N WATER WTR. GAS ELEC. 2nd 3rd 4th • Futuro Cons®cYloss Oq-nin�p Connocta with +s Now Fixture, Oleg Openings Sower Cesspool City of Fridley: The .undersigned hereby makes application for a permit for the work here! specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are rue and correct • nn1972 Owner Kind of Building) �•ii i l /l Qused as To be completed about PARTIAL RATE SCHEDULE Estimated Cost, $ PLUMBING FIXTURE RATES: NO. RATE TOTAL Old—New. Building Permit No. Pormit Ido. ���� Number Fixtures ............:.... x $2.00 $®' Future Fixture Opening ........... .3 x $1.50 $ q__ New Fixture Old Opening .....:.... - x $1.50 $,.__ Catch Basin ..................... x $3.25 $ Water Heater (Up to 99,000 BTU) .... x $3.00 $ 3• v D • New Ground Run Old Bldg......... x $3.25 $ ROUGH - Electric 9i/atar H"ter.............. : $2.00 $ ZAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures Z x $2.00 g J ®y Additional Fixtures .................. x $ .76 $ Gas Range to 199,000 BTU ... ,.......... x $5.00 6 sv REPAIRS ALTERATIONS --Refer to Coda, .50 State Surcharge .Description ...`� ........... , ............................ TOTAL A'EE 3 �tii ert j Signed Business No residence, 6361' Sgvire Dr. in Harr ition, are Fridley Mayor Bill -Nee, Ma septi Matusovic and children Mark and Michele. Joe Lake Matusovic, on the roof, begins repair work'. (Sun Ann photos by Howard Nyquast)," $60-3450 6431 UNIVERSITY AVENUE NE July 31, 1975 Weatherly Electric Box 80 Elk River, Minnesota 55330 Re: Electrical Permit Shortage Gentlemen: ANOKA COUNTY FRIDLEY, MINNESOTA 55421 In March and April, we sent you letters regarding permit fee shortages for the following addresses: 6371 Squire Drive N.E. v✓6361 Squire Drive N.E. Service $ 6.00 40/50 Outlets 10.50 10/20 Sockets 4.00 Furnace 4.00 Range & Oven 3.00 Actual Permit $27.50 Permit Paid 19.50 Amount Due $ 8.00 We have itemized this house in our letter of April 1, 1975. Amount Due was $16.2.5. You have sent us your check for $24.25 and we called and asked that these be placed on Minnesota State Electrical Affidavits. To date, we have not received them. Please be advised that when you send them in, add another $5.00 to each of the above addresses for Repairs Due to Storm Damage. We will expect to hear from you by return mail. Yours t�ruly, LEONARD EICHMILLER Electrical Inspector LE/cs 5� 11 S T`."+n T.•.!•1 �!�7 N. L•r.� ty• +-,!�S �'-. .�j!r•.nr"•�''^�'� tn.+.;7--;.•9 tcw�a '•P�•"l°^"F e- Eio: ....,�2,.� �r�. •�Y.� (1'osW.rv?f o tiCrer o .•.,+.ci.• �.�s:/? a� �...w�ou•l:II 4M.LOSiv.Ot'�.•a+$ :sV..�i.J..aw vw d �0 �.'/•ws.^uaAtver.:`.•� +ea ��:Jr:..tLL.:) Vx::3 K•rvi�ltrr:.,J -A'A7M AM: nPia TOTAL r ace she•II a ^rue, Work of e una-e 6.00 Rr'Pa:rs le A::r. .o.^. r- up to E: 00.00 61X3 S Re;a:rs L• Ai orations each add. 5500.00 . 3(,x3 $ F, r:sce• Shcll & Duct Work to I20,0W BTU ..$1000 ®� zed. co. -,"o BTU 3.iX3 S of r-i.:cc 6.00 S Ahe-at ons -up to 5500.00 6.00 $ F�:.irs be Altrratimi each add. $'>~?0.00 3.00 $ STr_-k f c: FOT WAiZA SYST -I mes- to i:"J sq. ft TZ?. Stewn 310.00 v Furnace G:'.% I & L:rc--•to 640 sq ft. EiR Hot Water 1000 S. EZCh adv" .,o SQ. ft En:; $team -4 fN) ZnCh add. 320 sq. I'% EDR Hot Water 3.00 S OII.. BUR*t�r.-to 3 gal. Dcr hour 6.00: S.______._.,,,., over 3 gal. per hour -See Tee Schedule GAS 3T:h _MR (up :o L`-�Z= BTU) 6.00 S ?S`?.Cx BTU Ss_: Fre sckodzlo CA3 iIT-.ASC F' :.5: F10 RAir. TOTAL Is -,3 F.xtures X2 7.00 S_"-2•6® Additio:ial ri^tL'reS X .75 S_..•_. —_ Gas Rano, ru IMM. s� 5.00 S 4 Ls•a , , Ll�te V!T �� J i State Surzharge •50 $I S,_* Too Scx v TOTAL 1 Sqige Dom', Ne City of FeLd%7: The under slY,r:ed hereby makes application for a pc=nIt for the work her -_4 spectfied aFrc-vmg to do all w•orle in s::let accordance with *_he CitF O -d!= :+ and rutir.g.of the Deya:tmrnt of rivildir.ds; and hereby decL•:rs th;t an the fac and reNr•:sPntatiuns stated in this apybcatiori ar true and cc::ect. Fndley. Minn 6-17-76 IQ Owner Richard Miller Homes Rind of Bulldin�- frame Used as residence Tn be completed about 6-30-76 Estimated Corti S Old --New. Building Permit No. _.__ . F®writ No. IUA7' TING or FO'4'R met Wat,=, Warm Air—No Trade Name West. _ Sac Hol . GUB-110E Ca acit 11000 Capacity—_ ._. Sq. I -Ft. c..D.R ar:'LJ Total Connected Loazd - 55r525' XLnd cf Tuel gas BUF.?,'ZP -- Trode Marne same Size No C2r..4city Sq. PL EM R i3"i'L7 West. SPO36E-3 ton A.0 . 's #4025 John V. Borry i�aaaaxs-.aerial Sfr• )C za;,=","� ]=RED VOGT & CO HEATING&AIR CONDITIONING '9260 Gorham Ave. `• $'3$'973r . St. Louis Park, AMtwsota 55426 CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL ` RATE TOTAL Furnace Shell and Duct Work, Burner (Also replacement furnace) $ 20.00 $ Gas Piping $ 10.00 $ (piping needed with new furnace) Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ * Air Conditioning (all sizes) $ 10.00 $ All Others/Repairs and Alterations 1% of Value of Appliance or Work $ COMMERCIAL/INDUSTRIAL 18, of Value of Appliance or Work $_ State Surcharge TOTAL rEE Reinspection Fee ($15.00) Rough Insp. Date Final Insp. 2 1.4 f ud Date Approval for Permit MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00 PLUS $.50 STATE SURCHARGE *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. $ .50 $Jd>-4--- $ Job Address � G =' `�"Ae— Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Tel. #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 are true and correct. Fridley, Minn. 19 �® y d KIND OF BUILDING X d -4 USED AS J'— c- % v TO BE COMPLETED ABOUT ® " 0 (� ESTIMATED COST L OLD - NEW BUILDING PERMIT NO. PERMIT NO. /n 1l� DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Gtd� G Trade Name 6 Size No. -5;�tTIY-d O == Capacity Sq. Ft. EDR BTU ' ,OZ Pdd�� Total Connected Load Kind of Fuel 7)6-, BURNER - Trade Naini / Size No. Capacity Sq. Ft. EDR BTU HP Company Signed By Tel. No. 7W ) 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 (\-rNo ( ) 3. Has no foreign objects lodged within = Yes (v -K No ( ) 4. Is securely supported Yes (vJ' No ( ) 5. Meets all current Code requirements for size and total BTU connected Yes ( No ( ) 6. Has Total heating BTU's of All other BTU's0<2t'� TOTAL Rema rk s Company Signed I Date pr SUBJECT City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. Ir � `y COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 6151? 1 16151? CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/26/96 JOB ADDRESS 6361 Squire Drive NE 1 LEGAL LOT NO. TRACT OR ADDITION SEE ATTACHED DESCR. JBLOCK 16 2 1 Harris Lake Estates SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dale Ronnie 6361 Squire Drive NE 572-0380 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Mike DeMars Construction 8401 166 Cir NW Ramsey MN 55303 441-7084 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 0 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE R B DESCRIBE WORK Reroof House & Garage 23 S 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 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 QFFSTREET 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 $1-0840 $.92 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 PROVISIONS OF AN OTHER ATE OR LOCAL LAW REGULATING CON- $59.50 Fire SC $1.84 STRUCTION OR T P F NCE OF CONSTRUCTION. /' PLAN CHECK FEE TOTAL FEE 12 b 1 License SC $5.00 $67.26 SIGNATURE OF COI TRACTOR OR AUTHORIZED AGENT IDA EI WHEN PROPS I.Y VA (DATED THIS IS YOUR PERMIT DG INSP DATE SIGNATURE OF OWNER OF OWNER BUILDER? (DATE) NEW [ ] Effective 3/1/96 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2,� Building Permit Application ConstructionAddress: 3 I S�- Legal Description: Owner Name & Address: �b\,L 3 C [ Tel. # 57 " ® � Contractor: f ('� 3 ,n C ,� ,/ �.,-o MN LICENSE # �� 6 Address: C"� L;t ga M5-e,,j Tel.# e/C// --7®i?Y Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EUPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hjt/ round Sq. Ft. OTHER: J o� 3 S Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Qe- gra o- 3 Estimated Cost: $ Approx. Completion Date: 4 •— (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft Ftx $ _ $ DATE: �f — 2 APPLICANT: _. �..------T ' Tel. # CITY- USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ /`, LJ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $900 per SAC Unit :.. - License Surcharge $ S-.610 $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 $ L STIPULATIONS: - ..