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PRE 2010 DOCSCity of Fridley, Minn.. BUILDING PERMIT Date: October 26, 1970 owner: John R. Williams guilder Same Address _6121 1.9t-.ar1jp_bt-_ Boulemard Address Same LOCATION OF BUILDING No. 6121 Street Starlight Boulevard Part of Lot Lot 14 __ Block 2 Addition or Sub.Division Alvan Hills Plat 2 Corner Lot Inside Lot Setback Sewer Elevation Sideyard Foundation Elevation No'"16873 DESCRIPTION OF BUILDING To be Used as: Garage Front 22 Depth 24' Height 10 Sq. Ft. 528' Cu. Ft. 5280' Front Depth Height Sq. Ft. Cu. Ft. _ ,` Type of Construction Frame Est. Cost $1,,400. oo To be Completed 1 monti Provide Hard Surface Driveway 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. • Y In consideration of the payment of a fee of $ 10.00 —,permit is hereby granted to John R. Williams 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 anworkmen, in all work done in, around and upon said building, or any part thereof, shall conform iu all respects to the ordinances of F dley,Ii?innesota regardhin thivancm NOTICE: 'this permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be euro to we the Building Inspector for Separate permhs for them Nems. F l APLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT NO: -.-"I' STREET: a LOT: 1 BLOCK: ADDITION: ayet CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As:. LOW -e- Front: Depth: .a 4A Height: ®® Square Feet: Z , Cubic Feet: ' ed Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: 4®tMhIF21 Estimated Cost: $ 191400 To Be Completed: t " The undersigned hereby makes application for a.permit for the work herein specified, agreeing to do all work in sttict 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: Gi' .�. � . �/ � SIGNATURE: (See Reverse Side For Additional Information.) i�. <'V1116'14 8 YMOND A G BRUNSWICK T. COYNE / OT SURVEYS COMPANY 5691 IDAHO AVE. NN 304 BRUNSNJICK AVE. S ` '�G GOLDEN VALLEY, MINN LAND SURVEYORS BROOKLYN PARK, MINN. REGISTERED UNDER, LAWS OF STATE Or MINNESOTA LICENSED BY ORDINANCE OF CITY OF MINNEAL"OLLS 6917 Idaho Ave. N. .533.9922 Minneapolis, Minnesota 55428 INDUSTRIAL - JUDICIAL i-f).M.P.INING MORE THAN 30 YEARS OF COMMERCIAL - TOPOGRAPHICALburbeparg Cert ficate LAND SURVEYING `XPERIENCE IN THE CITY LOTS - PLATTING WTROPOLITAN AREA JOHN WILLIAMS Invoice # 3100 P.H. 134-8 o Denotes Iran Scale 1" = 30' 0 l� tlJ �• �- '" 4e, Az"4F'11' � P Lot 14, Block 2, Sylvan Hills Plat 2 We hereby certify that this Is a true and correct representa- tion of a survey of the boundaries of the above described Signed a� � land and the location of all buildings and visible encroach- LOT SURVEYS compJkw ments, if any, from or on said land. :iurve;od % us this day of .-Q.C.' —, 197.0 F i 52-84-5915-51 City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of'Bldgs. Phone 560-3450 DESCRIPTION OF WORK 6121 Star Light Blvd Number, Kind and Location of Fixtures Location y 07 1 yyq y $ 12 $ x $3.25 2r� C N Sa00 Z ,iSj�u� $ w UN' Z • F • N WATER HTR. GA5 ELEG G O Base ns t G&s Pr5er 1st 2nd 3rd i—EiE 4th I I I —A • Future Connection Openings Connected with I Sewer El New .Fixture, Old Openings Cesspool El PARTIAL RATE SCHEDULE PLUUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin .... ....................... Water Heater (Up to 99,000 BTU) ...... New Ground Run Old Bldg . ............ Electric Water Heater GAS FITTING FEES: NO. 1st 3 Fixtures .......................... Additional Fixtures .................... Gas Range to 199,000 BTU .............. Gas Dryer 1 REPAIRS & ALTERATIONS—Refer to Code x $2.00 x $ x $1.50 $ x $1.50 $ x $3.25 $ x $3.00 $ x $3.25 $ $2.00 $ RATE TOTAL x $2.00 $ x$.75 $ x $5.00 $ 5.00 City of Fridley: The undersigned hereby makes application for a permit for the work herei 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 true and correct. Fridley Minn. 10-25-6t 19_ Owner , John Williams Kind of Building frane Used as res To be completed about 10-30m68 Estimated Cost, $ 10.00 Old—New. Building Permit No. _Permit No.Z�a' i e ° By Business Pho a No ...'" ROUGH FINAL A✓� Description ...........$ ............ 5e00 az TOTAL FEE $ CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 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 Water. Stories Closet Bath Urinal Tub Shower Wash Drink. Sink Tray Fount. Floor Catch Drain Basin Auto. Washer Gas Gas A pl. Range Misc. Fixt. Water Heater Gas Elec Basemen Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin NO. RATE TOTAL 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 $ 7.00 $ 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 JOB ADDRESS s O. S � \ q�',SL U, ! C 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 Building Division., and hereby declares that all the facts and representations stated in this application are true and correct. Owner��o��\c� Building Used As Estimated Cost PERMIT NO. oa;c) PLUMBING COMPANY Attfl+ My, minnegasco 700 W. Lind n u SIGNED BY �A Box Minneapolis, MN 554 ID -I 165 Approved By ( Rough- n Date Final Date State Surcharge $ .50_ MINIMUM FEE FOR ANY PLUTABING/GAS PERMIT IS $15.00 TOTAL FEE $ SS`�� PLUS THE $.50 STA E,,rS U RCIiARGE 199. CITY OF FRIOLEY INSPECTION DIV. 6431 vnivemity Ave NE Fricllell- M"4 55432 OIZ_3604 RATg SCHEDULE Effective On August 1, 1995 CITY OF FRIDi,.Ey INSPECTION ON. APPLICATION FOR POWER fIVi°tMiMSI!AN-D COOUfdG!V �p � p, r ga��� FOR POWER l�dTS'�1 9Ai ISG REFRIGERATION AND AIR COI�IltIl�lu S DEVICES,, 't�.-�Q0;�RFFFdI.aEF1A.-I'iOfol ,4i�Ci AIR GC7I�1C?ITfO'�J!'�tz ��MS A =?ti Residential Furnace Shell and Duct Work! Burner - Also Replacement Furnace (Side Vent Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (UST ON BACK 1 % of Value of Appliance or Work Commercial/Industrial 1.250% of Value of Appliance or Work JOB ADDRESI I I J % Y�%leLiDHI RAT SC Ef3 UE " fife ereby makes application for a permit for the work h; Rate TOTAL �pecified agreeing to do all Work in strict ac a e nce LCity Co39Y. eceda4 Residentla 0 s the it in Divis onoan&hereby ec res tha all e... n s qtr aces $ 9139 o� �a rn g _ rerese�n Mnos safed �n itis applicatio a �ano�rffrewce$30.00 $ $o Replac men urnacer � , nn rU ( Side Vent -� Fill 0-ut Back) ... � Ven" Full $10.00 $ Pipin dwi rn 0 0 �<6s x $10.00 $-mss ►fang 10,00 $ "F . ,.e UILDING USED AS SING $10.00$.00------- is l er $10.�`�Y ESiiMATED COST , PERMI $ 251.00 $ Conditioning Ali®�one►e n� m'c�NIA N® C1 -%#k >> TOTAL FEE MINIMUM FOR ANV HEAiItNG/COOLI1VGi1lEN"nLATIOIs1 EFRIG Ul11110 CONDITIONING ItAiT IS 525.00 P THE S 50 STATE SURCHARGE REINSPECTION FEE $42-OO/Hr "Air Conditioners can not be placed in a side yard without Written permission from adjoining property owner. ---% crtAro �a Size )\lo. �� dene _ =---rude air B HP EDS Commerc Total Connected Load '`��' �� Burner Trade Name -- ----St ffi Size No. �, mer Tri BTU P TCMRWLE INDOOR AEMAUlyr'NC. 2619 COCK RAPIDS BOULEVARD HEATING COM PIIf ,� � � ; oa h��, � -���i -- �@� lNG 'Air Rough -In Date r� Final Date propertyowner. 01 CHIMNEY 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's connected Yes () No ( ) 6 Has total heating BTU's of All other BTU's TOTAL 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: HEATING CO: Signed By: Date: 01 SUBJECT t - P City of Fridley P2'9 7 9 7 AT THE TOP OF THE TWINS BUILDING PERMIT � PT NO, • _____ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 1A176 .4 1 NUMpER REV DATE PAGE OF APPROVED BY I �-5 CITY HALL FRIDLEY 55432 612-571-3450 910415 6/30/99 JOB ADDRESS 6121 Starl i to Blvd. NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14 2 1 Sylvan Hills Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kim Verbrugge 572-0481 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 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 0 ALTERATION INX REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (20 S Tear -off 9 CHANGE OF USE FROM 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 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 1748 .87 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION 63 15 1 .75 PLAN CHECK FEE TOT L FEE SIGNATURE OF COyj RACTOR OR AUTHORIZEO AGENT tDATEP 77 ENIROPVV VALIOAT56 THIS I$ UR P R T 4�.NATURE BL -NSR TATE OF OWNE ��T OWNER BUIL DATi 01 NEW[ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Q��, q/p Construction Address: / 0 . JE-. r } ; �� Legal Description: Owner Name & Address: Tel. # -® (43 � Contractor: MN LICENSE # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: ao SC?. f c� r - 0 Construction Type: Estimated Cost: $ — <7� Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # CITY USE ONLY a Permit Fee $ �:J - �Sr Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ y $.50/$1,000 Valuation SAC Charge $ $1050 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 [ ] s ` i TOTAL $ STIPULATIONS: tis�'r iNSPECfION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON 1azr.T.,: Effective On Jan 1, 2002 PLUMBING FIXTURE RATES: JOB ADDRESS New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 3`- , 20 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner ef3rgS!pef,, Water Heater -Electric $ 7.00 Water Heater - Gas** $10.00 /d::h '® Building Used As ; Gas Range** Gas Dryer** $10.00 $10.00 Estimated Cost �'�.5 PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMPANY Reinspection Fee $47.00/Hr 6l� SIGNED B TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS FAX # 1.5% of Value of Fixture or Appliance Approved By� Rough -In Date Final D State Surcharge .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 TOTAL FEE $ PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO 0 BACK SIDE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON VENT. VFNT _ONN _TOR AND r-QMR1 ISTION AIR VFRIFI _ATION When re In acinagan existing furanr_e, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes#) No( } The venting system is plastic/PVC and meets all current codes and manufacturer /� specifications including sizing, length, number of elbows and termination. f uses () No ()��. The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does a' include AGA-GAMA Category I Central Furnace Venting Tables for fan AIA assisted and natural draft appliances. Yes ( ) No ( ) The exp i�cttng cnmbuctinn air is sized and installed to meet the current codes and manufacturer's specifications. Ye No( ) When required to install a new r-nmhi ,Minn air, it will be sized and installed to meet the current codes and manufacturer's specifications. IVJYes () No ( ) When installing a new venting cyc_tem, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. 4Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented ,{ separately as per current codes. � Yes ( )No( ) Appliance Type and Size/Common Vent and Vent Cnnnectnr Informs inn L-4 vv�cr Appliance #1 Type BTU Input �GOWe I or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances _ Total Btu Input Common Vent Type Vent Height Diameter inches 1.119 Appliance #1 Vent Connector Height ft Length ft Diameter. in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type /,ies < ®w1k11 e -, SUBJECT. P City of Fridley 32482 AT THE TOP OF THE TWINS BUILDING PERMIT E PT N • I DEVELOPMENT COMMUNITY DEVELODV. r � � PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 3/28/02 JOB ADDRESS 6121 Starlite Boulevard NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14 2 1 Sylvan Hills Plat 2 SHEET 2 PROPERTY OWNER- MAIL ADDRESS ZIP PHONE Kim Verbrugge 6121 Starlite Blvd NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO MN Remodeling & Restoration Co 310 Meadow Lane, Golden Valley, MN 55418 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 763-377-7858 4789 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION 1 REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Replace existing windows within existing openings 9 CHANGEOFUSEFROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section. 310.9.1.2•of the 1997 Uniform Building Code. SEPARATE PERMITS ARE REOUIRED 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 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 $1,500 $.75 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 ANY OTHER STATE OR LOCAL LAW REGULATING CON- $54.00 Fire SC $1.50 STRUCTION OR TMEEPRFRMA E OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE �'� Licens SC $5.00 $61.25 "� SSG ATURE OF CON' CTORO THORQED AGENT 40ATEi W N PROPERLY VALIDATED THIS IS YOUR PERMIT IfLp 50 �(� oArE S-GNATURE OF OWNEAoF OWNER BUILDER, IDATE, I I NEW ( ) ADDN [] ALTER ( ) Construction Address: (a/ o< / Legal Description: _'�i' k Owner Name & Address: ,`Alk CITY OF FRIDLEY Effective 1/1/2002 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION if , '10� /'vJ. Ulm Tel. # Contractor. SAI• /Ze^bg1,/•�-. -6-/Z e s �or�'r,®�. G� MN LICENSE# Address: 3 (a !fie a a,`, j� ��%� �' Tel. # 763-377-70'5? LIVING AREA: GARAGE AREA: DECK AREA: OTHER: 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 Height Sq. Ft Length Width Height Sq. Ft Length Wdth Hgt/Ground Sq. Ft w i Alr/c'W5 tai, Construction Type:_ Estimated Cost: $ al5�o Driveway Curb Cut Width Needed: Ft + 6 Ft= Ft x $ —=$ DATE: 3 3— APPLICANT. ®lel Tel. # 61a —;z of- 9 '?® D Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge $ ' =o(opy $ /b' Os' $ a 9S- CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1200 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by*Engineedng Agreement Necessary [ ] Not Necessary [ ] TOTAL $ / STIPULATIONS: