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PRE 2010 DOCSCity of Fridley SUBJECT PER O. 13775 AT THE TOP OF THE TWINS PERMIT -` DVIL®Ivv NO • ______ COMMUNITY DEVELOPMENT DIV.�� L PROTECTIVE INSPECTION SEC. JEC;EIPT t✓ 1 . � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 9/22/76 JOB ADDRESS 6370 Starlight Boulevard N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 4 Sylvan Hills -Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Charles Aspenson 17 Rice Creek Way N.E. 3 CONTRACTOR MAILADDRESS 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 ClX NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 45' x 25'6" Dwelling and a 24' x 20' Garage ora Gigging W1 §VWT ELECTRIC - GAS Etc. P�3ONE - 9 CHANGE B P�uM�biNC awo stGN,�TQ REQUIRED 13Y LA � ATtM�► . STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before capping. Provide sod in the front and side yards. Provide copy of truss design before capping. Provide vapor barrier in ceiling. Set house back 37 feet to allow for cantilever in front. SEWER LOCATION: (Approx. 9' Deep) 144' North of Manhole (N. Inv. 834.5) WYE ELEV: 835.59 TOP OF FOOTING: 838.59 Minimum WATER LOCATION: 9' South of sewer service or ow OM NIX . OVA"M - THE 'IMP rtAA%. ACCOM& OF unm WCAT10113 IIIA NPAP:a:; ®MA , �vzrVi3�® yAW3VrpIl Tll Vdl W V1 na vtil�.1 r APPLICATION FOR RESIDENTIAL ALTERATION, ADDITION, OR REPAIR- BUILDING PERMIT OWNER'S NAME:_ --6-1p C /_BUILDER: S� �7 ADDRESS : "e. P Ui noto ADDRESS :� P NO:. fr"3 9 STREET; Z Af h�9t v LOT: BLOCK: ADDITION: G` / 1 CORNER LOT: INSIDE LOT :SETBACK: SIDE -YARD: / 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: j Front: __ '4! Depth :or Height JL Square Feet: %IZQ z7 Cubic Feet: Front:Depth: g / Hei ht: Square Feet;_ 4/90' - Cubic Feet: 48C;kC) Type of Construction: _r-�gzz& Estimated Cost: r To Be Completed: _ A��� % 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: _� SIGNATURE: (See Reverse Side For Additional Information.) ®� 7y0 -A01 5 od,ve cv^/aro" 00 9 40V'(44 3� -7,41,93 3 ? r Ofe e -a .A, C4- BUILDING PERMIT FEE SCIIEDULE SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection: of any building or structure, or for any addition to any existing building or structure, or for any alteration or repairs to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth anal in the manner herein provided to -wit: NEW CONSTRUC`QION: Single Family Homes and Garages: $4.00/1000 cubic feet PLAN CHECK: 25 percent of building.permit fee. ADDITIONAL INFORMATION For the purpose of computing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or the cellar to the average heights of the upper surface or to the average.e height of the roof surface of the main gable of a pitched roof. For repairs.or alterations to an existing structure, the fee shall_ beet the rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof -in the cost of all proposed work. In no case shall the fee charged for any permit as set forth in Section 2 be less than $7.50. VERIFICATION OF FOUNDATION NOTE: Permits forconstruction will be issued a minimum of 24 hours from the time of application, to allow for proper review of the proposed structure and of the construction site. A Certified Survey of the lot, showing the location of the foundation, once it has been constructed, will be required before proceeding with the framing. CERTIFICATE OF OCCUPANCY Application for a.Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. t f -�AO 01 oc- e - --- -- k— I N I ' � f 1 I s 10, i ----- /�� I I II i !I 7 tt } .n a $v. k ,a, '� t�' v. w � .c -1F, ,r�' ;:� 'r l �,.,t �"�:f�` K !a a'k ��c r7' i�'� � v �..::...,°w t,,.,, •, G �'\ �-7< +yK.: �t a +' ' }1�?'r r 1 ��� y,k � ', � x�, �:�� �'�{ �b��ry�,� 5's r.s��, '�€p i �� �.'� ,� ! �����,"f~s �t 3 • , � �i� � �L yt,+y � s s sr 4i �,` ' �g 6 .7 ]M `f ♦>^ t 1 F * S 3 i�"�,+� : 5 3. ti #" , �. WA%4 SFTTtiN ^` t�l'►'w / i�++ d��%y""✓ �.�,GEF:g ;t F. 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YJi S L " WAVE: f 05 unnyus coal old- pri Or ;,� •�.'� +A 4x' Fn iii y All N", X41.L+*�5 7'4' \r rfa. a t `� ,a'^ if rA �iM" u A J3 }}rr X YI a s:, i�,t+��'avfrx ala a j�1y4k L 47}, Ads -WORD, kI �" ;'� �... YF,*¢`. eR, g + d a n f . 't ��•'p '51 .4,, s yq �^d. "t 2$z • #`� , ks rMUM s a s n s ': y. - .,c.x axe ✓a� Z - 3 +a ., .y.. Rai $#- i fi # r a Y. , RW WON k:,. xYa av apc y r ° # 1m 1m 'rns a. r4 atrx x S i? i 'ks,»nn ON TR Lz 11JL7 "�+4k•F�yYr 6•T ` 1r y C a� h'�e � � �[fl{1�I:. y»• y ' inv�r-1 i flip° 498 �� „4!'' -..ice a�'!'�ii/ �' � - • ��� � �?. ,�.- tl . '" , i R •,,ISE,a+"'�«�-+IV.�.�w;,�L'�,�1'G�;�f.� i3yri� !�/Z i �`�i,; �' �rw .. r �av*y ix Au ;Y 5�'� 5��'s�' w� ��i' '}�^�Y' `�"`� �.} " �►w�, '+ � iCi ���rt y,� �.a. `k'ye`4 ;�r ' * e � �' r j, //''����IC �1p' e 'LT}�i ?': „: �'.7.f�. dryro �.o V 3 r tai r ` k x�r -4 t dt y am'/ 3 saa jJ # xI�... OT U. j4o, i .` '..{ �+'ti i. rr�. 1• Y, 4N x � � � � � � \� � � � � � 2° � _ � /� � \� \\ ����5\- �\� � � \: - �� «� w «\\ - _� � a� - �� � � � � \\� �� 2 ��, x� � � \� /\ � « <� .� < , ��2w� CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Y='' er Fixtures _�x s3.ao ® S Future Fixture Opening �° x X d 'New Fixture, old Opening Water $2.00 $ Catch Basin .0 $5.00 $ Sro+ C •.Ci m O 100,600 BTU to 199,000 BTU y W W water Softener r. Heater $ Tlew Ground R:.•.. Old Building r. $5.00 $ Electric %ater Heater x $5.00 $ GAS FITTIVG FEES: 1st 3 fixtures � � $ 3 C9 D Additional Fixtures x L •� .d 4j L'1 G N C ••a U :t O O U V• 4 1J V; G .0 0 th N j U N �Jf 0 = M $4 ro h( q .., N ro ? N o q W U: � ro ro� M 'L = M U � .4 ro " O ;a :lex to x! q 1 1 ! lst ! `2nd 3rd 1th , I (R) Future Connection Opening Connected with Sewer (*) a .'•�:� Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Y='' er Fixtures _�x s3.ao ® S Future Fixture Opening �° x $2.00 $ cDCJ 'New Fixture, old Opening r. $2.00 $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU ^L x $5.00 $ .-® U 100,600 BTU to 199,000 BTU x $10.00 $ water Softener r. $7.00 $ Tlew Ground R:.•.. Old Building r. $5.00 $ Electric %ater Heater x $5.00 $ GAS FITTIVG FEES: 1st 3 fixtures _L x $3.00 $ 3 C9 D Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $10.00 S REPAIRS $ ALTERATIONS First $100.60 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $® REINSPECTION FEE ( $10.00) Job Address —&,5 76 Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all wort: in strict accordance with the City Coes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correcs Fridley, M t. PAY "�C ) OWNER KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST �QOLD -r__� UILDING PERMIT N0. -7 ?eS® PER`2IT NO. ROUGH INSP. Company Signed Tel. No Date FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 CITY OF FRIDLEY APPLICATION FOR POWER .PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE' GRAVITY IiAIM AIR: RATE TOTAL Furnace Shell & Duct Work $12.00 $ Replacement of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $ Repairs & Alterations each add. $500.00 4.00 $ MECFANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU $12.00 $ AZ O 0 O�5 each add. 50,000 BTL' 4.00 $Z1- Replacement of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $• Repairs & Alterations each add. $500.00 4.00 $ STEkl,f OR HOT WATER SYSTEM : Boiler & Lines up to 100,000 BTU each addn. 50,000 BTU Boiler only up to 100,000 BTU each addn. 50,000 BTU OIL BURNER= to 3 gal. per hour each add. 3 gal. per hour $12.00 $ 4.00 $ 7.00 $ 6.00 $ $10.00 $ 10.00 $ GAS BURNER- fro.. 100,000 BTU to 199,999 BTU $10.00 (over 199,999 BTU see Fee Schedule) GAS FITTING FEES: 1st 3 Fixtures x $ 3.00 Additional Fixtures x $ 1.00 Gas Range to 199,000 BTU x $10.00 AIR CONDITIONING FAN HEATING SYSTEMS See Fee Schedule VENTILATING SYSTEMS ALTERATIONS $ REPAIRS l - State Surcharge TOTAL FEE ROUGH INSP. REINSPECTION FEE Date ($10.00) FINAL INSP. .4 J r� - /" O L Date APPROVAL FOR PERMIT .3� MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 $ /0.00 S Job. Address (/J 3 2�_) Department of Buildings 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. � `0 19 ✓JO OWNER KIND OF BUILDING USED AS &-A-) ^ G TO BE COMPLETED ABOUT i ESTIMATED COST OLD 1NEW UILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURN-ER HEATING or POWER %PLANTS, Steam, Hot Water, Warm Air- No. Trade Name Size Size No. Capacity Total Connected Load BURNER - Trade Name Sq. Ft. EDR BTU // HP 6 ?find of Fuel ol a-5 Size No. Capacity _ Sq. Ft. EDR BTU HP Company Signed By Tel. No. _ �J May 26, 1977 C"ONTV OF- Ip LEY 6431 UNIVERSITY -AV'ENU'E 'N. E.; FRIDLEY, MINNESOTA 55'432 TELEPHONE, (612)571-3450 Mr..Charles Aspenson 6370 Starlite Boulevard N.E. Fridley, Mn. 55432 Re: Electrical Wiring Correction Dear Mr. Aspenson: We cannot give final approval on the electrical work done at your address. The National Electrical Code requires that the bathroom and outside receptacles be protected by ground fault breakers or ground fault receptacles. This must be corrected and a reinspection called for before the final approval can be noted. If you have any questions on this matter, please feel free to contact me at 571-3450 between 9:00 A.M. and 10:.00 A.M. Sincerely, LEONARD EICHMILLER Electrical Inspector LE/mh CITY OF FRIDLEY APPLICATION FOR PO ER PLANTS AND HEATING, COOLING, VENTILATION, .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work $12.00 $ Replacement of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $ 1 Repairs & Alterations each add. $500.00 4.00 $ MECHANICAL WARM AIR: I Furnace Shell & Duct Work to 100,000 BTU I $12.00 $�_ each add. 50,000 BTU 4.00 $ Replacement of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $ Repairs & Alterations each add. $500.00 4.00 $ STEAM OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU $12.00 $ each addn. 50,000 BTU 4.00 $ Boiler only up to 100,000 BTU 7.00 $ each addn. 50,000 BTU 6.00 $ OIL BURNER- to 3,gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $ GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $L (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: e 1st 3 Fixtures x $ 3.00 $ 3" Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00 $ AIR CONDITIONING $ FAN HEATING SYSTEMS See Fee schedule $ VENTILATING SYSTEMS $ ALTERATIONS $ REPAIRS $ State Surcharge $ .50 TOTAL FEE $2=5� _�o ROUGH INSP. REINSPECTION FEE Date ($10.00) FINAL INSP. & 31- 2 5 Date APPROVAL FOR PERMIT ly MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE REFRIGERATION AND Job Address (�370j--'k6i . Slyd, Department of Buildings 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 C6des 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. -1 e , 19? OWNER W - vwl.%dll�_� KIND OF BUILDING fd'r USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. 1/ � J PERMIT NO. J /& . DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam,_Hot Water, Warm Air- No. Trade Name Size No. �( Capacity Sq. Ft. EDR BTU , HP Total Connected Load 2- C� Kind of Fuel BURNER - Trade Name' Size No. Capacity Sq. Ft. EDR BTU HP Company Signed Bycrn moi% Tel. No. CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE Effective On March 1, 1996 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS-( 1 vre� State Surcharge 50 TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/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. Burner Trade Name Size No. BTU HP EDR HEATING CO PANY -+A I Signed By Tel No.10j _-1 l -IAn I Approved ByRough-In Date Final Date FILL OUT BACKSIDE F R STACK VERIFICATION ON REPLACEMENT FURNA E 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 Furnace $ 30.00 $ -)CSL, representations stated in this application are true and correct. (Side Vent - Fill Out Back) new _ _ ------ - �— - ,1912 Gas Piping (Needed.with furnace) $10.00 $ OWNER Gas Range $ 10.00 $ ' BUILDING USED AS Gas Dryer $10.00 $� ESTIMATED COST 41",)(7)t) PERMIT N0. "_'j'- t"_ *Air Conditioning - All Sizes $ 25.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) I% of Value of Appliance or Work $ No. of Heating Units l Circle One (Steam) (Hot Water) arm Alr Trade Name Ll I y Cj a Size No. Commercial/industrial BTU (Q(�. CX7CD HP EDR 1.25% of Value of Appliance or Work $ Fuel ' Total Connected Load State Surcharge 50 TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/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. Burner Trade Name Size No. BTU HP EDR HEATING CO PANY -+A I Signed By Tel No.10j _-1 l -IAn I Approved ByRough-In Date Final Date FILL OUT BACKSIDE F R STACK VERIFICATION ON REPLACEMENT FURNA E 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: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CH]AMY 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 (D() No ( ) 3. Has no foreign objects lodged within Yes () No (m) 4. Is securely supported Yes No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes( V) 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: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: FA SUBJECT ERMITNJ;� city of Fridley3 0 2 AT THE TOP OF THE TWINS BUILDING PERMIT r � RECEIPT NO. � • _ COMMUNITY DEVELOPMENT DIY. � tV INSPECTION SEC. ��� t♦ PROTECTIVE F'105 NUMBER REV DATE PAGE OF APPROVED BY I CITY HALL FRIDLEY 55432 612-571-3450 910415 9/23/99 JOB ADDRESS 6370 Starlite Blvd NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 4 Sylvan Hills Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Rolf Smeby 571-0002 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Panelcraft of MN 3118 Snelling Ave S Npls MN 55406 721-662R 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 O NEW ❑ ADDITION 0 ALTERATION X® REPAIR 0 MOVE O REMOVE 8 DESCRIBE WORK Reroof house and gaaraZe 19 S Tear -off; 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Call for building wrap inspection before covering. Provide soffit ventilation to meet the State Building Code. a-®rmit Inspection Card] Will Be Wailed �°® ®e , oz Th lnp� SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING. HEATING, TYPE OF CONST. OCCUPANCY GROUP OttbOANCYLOAD 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 1F 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 $12,025 $6.01 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE 12.02 $P PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- ` STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $223.25 FAre SC tftgn PLAN CHECK FEE TAL FEE Lice C 0 246.28 SIGNATURE OF CONTRACTOROR AUTHORIZED AGENT IOATEI H N RLY V I TED THIS IS UR ERMI LOG INSP L4 TE S,GNATURE OF OWNERIIF OWNER BUILDERL I5ATEI FA i�EW I I L11cctive 1/1/94 AD1 N I I CITY OF FRIDLEY ALTER I SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application A6 ►structionAddress: �Q� Legal Description: Owner Name & Address: �d/� ��?�� 37® s�g�/ /0/"/Tel. 11-®00�-- contractor:_ �� �¢ ar MN LICENSE 11 7 Address: .3//,` Swell` Tel. 11 7_2/' �Olp 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 ARCA: Length Width Height Sq. Ft.- DECK t.DECK AREA: Length Width Hgt/Ground Sq. Ft. OTI-IER: Corner Lot I I Inside Lot [ I Ft. Yd Setback Side Yard Setbacks 'fume of Construction: 5'W:��, Sa<F���s���-� J�oo /:h /9O Estimated Cost: $_ M Completion Date: 6f U (Cost on .Back) Driveway Curti Cut Width Needed: Ft. + G Ft = Ft x $ __ = $ _ DATE: _. � I � �° APPLICANT: Tel. 11 7 - 0 - (o�o a� CITY USE.—OK—Ly Permit Fee $ Fee Schedule on Reverse Side Eire Surcharge $ .001. of' Permit Valuation (1/ 10th l ) State Surcharge $ 4;,tOi $.50/$1,000 Valuation SAC Charge $.-_-_.__`__ ___ $800 per SAC Unit License Surcharge $ _5 D% $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 Char};c $ - _--- _ - Agreement Necessary I I Not Necessary I 1 TOTAL $_ STIPULATIONS: