PRE 2010 DOCSCity of Fridley,
BUILDING PERMIT z! ��
Date:
Owner: Builder
Address Address
OCATIONBUILDING"
No. l_ Street _ _:++"_. P Lot
Lot __�_ .__ Block _�. Addition or Sub -Division _
Corner Lot _ Inside LotSetback _ Sideyard
Sewer Elevation _ _ _ _ _ _ Foundation Elevation
DESCRIPTION OF BUILDING
W',e U a:
Front - Depth Height Sq. Ft. cu. Ft. .
Depth Height Sq. Ft. Cu. Ft.
Type of Construction Est. Cost y,, —moo 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.
el
In consideration of the payment of a fee of $ �_ r _"~ ., 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 of any of the provisions of said
ordinances. "S
ding Inspector
e;Y
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we
the Building Inspector for separate permits for these items.
4
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOT.,
e
Owners Name
Address
"AM
LOCATION OF BUILDING
No. ��/� Street Ale'K-' Part of Lot
Lot _Block 2i Addition or Sub.Div.- 1✓�
Corner LotInside Lot____.Pet Back Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
Front D'
Sq. Ft.Cu. Ftt
Iz
Sq. Ft.
Front Depth Height
Cu. Ft,
Type of Construction _.%.�..PE stimated Cost -6 -
To
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 representa-
tions stated in this application are true and c,pyreatf
DATE �� ��SIGNATURE
(A Schedule of Fee costs can be found on the Reverse Side.)
BUILDING PERMIT FEE SCHEDULE
Section 2. The Inspector of Buildings shall, before issuing any permit
for the erection of any building or structure, or for any addition to
any existing building or structure, or for any alterations or repairs
to any existing building or structure, upon application therefor, require
the payment by the applicant for such permit of fees to the amount herein
below set forth and in the manner herein provided to -wit:
2.1. For any such permit for the erection of any fire -proof building, other
than a garage, warehouse, factory or grain elevator, or for the erection of
any fireproof addition, for similar occupancy, to any existing building
shall be at the rate of $1.40 for each one thousand cubic feet, or fraction
thereof, in such cubical contents.
2.2. For any such permit for the erection of any fireproof garage, ware-
house, factory or grain elevator, or for the erection of any fireproof
addition, for similar occupancy, to any existing building shall be at the
rate of $1.25 for each one thousand cubic feet, classified as "fireproof"
by Section 502 of the Minneapolis Building Code.
HOUSES
2.3. For any such permit for the erection of any non -fireproof building
other than a garage, warehouse, factory or grain elevator, or any non -
fireproof addition, for similar occupancy, to any existing building.
Permit $1.00 for each one thousand cubic feet.
GARAGES
2.4. For any such permit for the erection of any non -fireproof garage,
warehouse, factory or grain elevator, or for the erection of any non -
fireproof addition, for similar occupancy, to any existing building or
for each such building or addition. Ninety Cents for each one thousand
cubic feet or fraction thereof, in the cubical contents thereof with a
minimum of $4.00.
For the pu-'"pose of computing fees for building permits the cubical contents
of any building or addition to a uniform height throughout by multiplying
the ground area covered from a point six.(6) inches below the floor line of
the basement or cellar to the average height of the upper surface or to the
average height of the roof surface of the main gable of a pitched roof.
2.5. For repairs or alterations to ari existing structure, the fee shall be
at the rate of $3.00 for each Five Hundred Dollar's ($500.00), or fraction
thereof in the cost of all proposed work.
2.6. In no case shall the fee charged for any permit as set forth in
Section 2 be less than $4.00.
o9e �
City of Fridley
Application for Plumbing and Gas Fitting Permit
Dept. of Bldgs. Phone SII 4-77470 jl
DESCRIPTION OF WORK Location
Number, Kind and Location of Fixtures
80
I~
y�
�
_u�}
ZZ
Ou°ff
,
Uw`
Z
•
i
WATER HTR.
O
<
� °1
��F
Z
G oy
K=
J�
c
3
�
� Z
Q a
00
R
N
GAS
ELEC.
iii
m
w
3F
c�
a
u o
t�m
0°d
U4n
Base
1st
%
2nd
3rd
4th
• Future Connection Openings Connected with
New .Fixture, Old Openings
PARTIAL RATE SCHEDULE
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- 19
Owner go 01A O'l., )3,6114h d
Kind of Building
Sewer ff Used as
Cesspool ❑
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... x $1.50 $ 00
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 $
GAS FITTING FEES:
1st 3 Fixtures ..........................
Additional Fixtures ....................
Gas Range to 200,000 BTU .............
REPAIRS & ALTERATIONS—Refer to Code
NO. RATE T//OT��AL((��
x $1.50 1$�
— x .50 $
— x 2.00 $
To be completed about
Estimated Cost, $
Old—New. Building Permit No j� Permit No.
Signer] le
By / ►
Business PhV-- No 7 `.7OW7
ROUGH 6 - 17 411
FINAL
Description ................................................$
TOTAL FEE $/� dz 2M
6` r
Application for Power Plants and Healing. Cooling, Ventilation, Rehiga%stion and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU. 4-7470
QRAVITY WARM AIR: RATE TOTAL
z
Furnace Shell & Duct Work .......................... 8.00 $
y 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 ....;a .................. 2.00 $
Replacement of Furnace .............................. F§.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. EDR Steam.......
8.00
$
Furnace Shell & Line—to 640 sq: ft. EDR Hot Water ...
8.00
$
Each add. 200 sq. ft. EDR Steam ......................
2:60
$
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) .......................
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
Fi E
$�
ROUGH—
OUGH
FINAL—
FINAL
City
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 ancorrect.
ldley,Minn-JUN 19 1 61
19
Owner
Kind of Building
Used as
To be completed about �AuG 19 r�
Estimated Cost, $
09 ew. wilding Permit No. Permit No.
DESCRIPTION OF WORK
HEATING ,Warm "—NO-1—
Tra:7
7
de Nam Size
Capacity.
Total Connected
BURNER — Trade
G BTU H.P.
Kind of Fuel
Siz No
Capacity Sq. Ft. E.D. A- 0_ H.P.
/O C,[C).
(REMARKS-OVER)
Signe
,, .42 2M r -ss Business Phone N
t
n.s6 Z f,
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS
Weatherstrips A.S.H.V.E. Construction No.
Guide
Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor
Yes—No I Yes—No 19—
MINWAPOUIS. MINN.
Insulation
Kind How Applied
I R.1 /. -. _ i r.. Renm I Length 0 °i Width / t/ Height A 1 I FI_I — :W Rnnm I Length I Width ,onrr Height 9e
Windows and Doors—Crackage and Area
0
10:
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
a
G�
Coef. Btu
Infiltration 1
Coef.
Coef.
Coef.
Btu
Infiltration
®/
M
Ceiling
Glass
O / O
Glass
50 .
Exp. wall
Exp. wall
an v
-5 o 0
Exp. wall
Net exp. wall
7
O
Q
Net exp. wall
Int. wall
Floor
C)
h&-Wa&
F,'
O
Floor
Floor
Ceiling
&
6 �®
`j 6 IG
Floor
3 ®
T 0
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
1 FU [1) e „i .. Room ( Lensith J/ Width / / Heistht
Windows and Doors--Crackage and Area
0
10:
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
a
G�
Coef. Btu
Infiltration 1
Coef.
Coef.
Btu
Infiltration
t
®/
M
Ceiling
Glass
Q Z 0 Q
Exp. wall
50 .
Exp. wall
Exp. wall
an v
� f7
Net exp. wall
Net exp. wall
O
Q
13 6
Int. wall
Floor
By /I
Ceiling
Floor
Floor
�%
&
6 �®
`j 6 IG
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
A Fl.l I,,": -r- Room I Length t :Z Width / Heiaht 4Z,-
Windows
Zl
Windows and Doors—Crackage and Area
0
10:
Width Height No. of Lineal ft. Area
No. o1 pane of pane lights of crack sq. ft.
a
G�
Coef. Btu
Infiltration 1
Coef.
Btu
Infiltration
Exp. wall
t
®/
Glass
Ceiling
60
Q Z 0 Q
Exp. wall
Floor ®�/680
Exp. wall
Net exp. wall
a
Net exp. wall
Int. wall
O
Q
Ceiling
Floor
By /I
Tbtal Btu. '
Windows and Doors—Crackage and Area
0
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
C3
Coef. Btu
Infiltration 1
3-6 '0
Glass
5
Exp. wall
t
Net exp. wall V71
Int. wall
9 123
Ceiling
Floor 3
5(040
Total Btu. Lao
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
I Fl.l P ,.:� . "n Room I Length 7 Width S Height
Windows and Doors-Crackage and Area
/
hi
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
a �L/ )
Coef. Btu
Infiltration
Glass
Infiltration
Exp. wall
t
Net exp. wall
3�- MO
Int. wall 6 -
Ceiling
Floor ®�/680
Exp. wall
Total Btu.
Required sq. ft. E.D.R. or sq. iris. W.A. Leader area I
i F1.I(.- r At-► Room I Lenaffi ► .5 Width ) / Height Q
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of -pane lights of crack sq. ft.
a �L/ )
Coef. Btu
Infiltration
t
3�- MO
Glass
-60 1 a 0
Exp. wall
a
Net exp. wall
O
Q
Int. wall
Ceiling
Floor
y
19
&
6 �®
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. leader area 11 Required sq. ft. E.D.R. or sq., ins. W.A. Leader area
I A
tv
WS z a�
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS
Weatherstrips A.S.H.V.E, Construction No.
Guide
Windows ( Doors Reference Out. Wall Int. Wall Ceiling Roof Floor
Yes—No Yes—No 19—
I F1.1 (1d, C r t_') Room I Length I U Width / 0 Height 9,-' II Fl.l
Windows and Doors—Crackage and Area
0
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef.1 Btu
Infiltration
JCoef.j
Btu
Infiltration
Lr
3
/oqv
Glass
®iv
-10
0
Exp. wall
/ O
Net exp. wall
Int. wall
-a 0
Ceiling
Floor
o I L/O
A vo
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
1 Fl.l i v ,^ 0'A Room I Length 1 I Width ® ri Heistht
Windows and Doors--Crackage and Area
q
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef.1 Btu
Infiltration
Coef.
Btu
Infiltration
Exp. wall
3
a 9D
Glass
®iv
-10
0 0
Exp. wall
/ O
Net exp. wall
-a 0
Int. wall
Ceiling
Floor
/ 0 0 0
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Length Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef.1 Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Tbtal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
r mss
l�
MIM4APOLIS. MINN.
Insulation
Kind How Applied
Ream I Length Width Heiaht
Windows and Doors--Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane light; of crack sq. ft.
Coef.1 Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl.l Room I Length Width Height
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
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area f
F1.1 Room I Length Width Height
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
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. ED.R. or sq. ins. W.A. Leader area I
!. `\
!� ��y�f
e ��(„
� �.
b � � ®S
� ��.
c.
�9 �' ��
f
SUBJECT
P
City of Fridley
15 7 4 4
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
r
�
NO
• COMMUNITY DEVELOPMENT DIV.
;RECEIPT
r � � PROTECTIVE INSPECTION SEC.
1 �
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
',j
612-571-3450
910-F15
5/27/80
JOB ADDRESS 1517 Trollhagen Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
8
2
1 Innsbruck 2nd SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Norman Bahr 1517 Trollhagen Drive N.E. 571-6332
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
9 CHANGE QF USE FROM TO
STIPULATIONS
Roof can be 2nd but not 3rd roof. Install ridged galvanized valleys.
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
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
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
$660
$.50
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$8.00
ATURE OF CONTRq� Ro HG DAGENT (DATE)
WHEN PROPERLY LIDATED THIS IS YOUR PERMIT
t\ J
jLQ�
�_ LA's
BLDG iNSP r)AII
SIGNATURE OF OWN F WNER BUILDERS AT
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(New, Alterations, Additions, or Repairs)
OWNER: %`deli'qjl 4 ill BUILDER:G�
ADDRESS: At"2 sL0Z11hWP'C•V C ADDRESS:
TEL NO: �� �' TEL NO:
Construction Location
STRENT NO: 1-511 STREET: jam® c� �/��� _X ��
LOT: I BLOCK: ADDITION:
Corner Lot: Inside Lot: Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
�Q - D'C 46eS67-Front:
Squane.Feet:
Front:
Square - Feet:
Depth: Height:
Cubic Feet:
Depth: Height:
Cubic Feet:
� eo
Type of Construction: /6—/,ewo�r/,vPEstimated Cost: $
To Be Cbmpleted:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET
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 thi.
DATE: SI
Stipulations:
7IS-0
110
BUILDING PERMIT FEE SCHEDULE -
SECTION 2. The Inspector_ of nuildincls shall, before issuing permits for the erection
of any building or structure, or for any addition to any existing building or structure,
ar 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 and in the manner herein provided to -wits
NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet.
PIAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSION: (Concrete, Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x 1,15.75
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3 foot wide approach with
6 inch depth; Driveway width plus 6 feet x_$17.85
_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 height of the roof surface
of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the rate
of $3.00 Pier 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 plus $.50 state surcharge.
VERIFICATION OF FOUINDA]" I 0[L
NOTE: Permits for construction will be issued a minimtmn of 24 hours from the time
of application to allow for proper review of the proposed structure and of the
construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
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.
':"2oo S -
NEW [ ] CITY OF FRIDLEY
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: S f 7 11n AIF
Legal
Description:
Owner Name & Address: onTel. # s�
Contractor: o� i C ` r vt MN LICENSE # ��� r 6 0-5
Address: I r) R t 9 72- e&A (1, u> A e- Tel. # 2,3 7--R1 0-5
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 Width Hgt/Ground Sq. Ft
Construction Type: e. r6op Estimated Cost: $
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$
DATE: '' 6—C) S APPLICANT: P -0.9-c- ir t i- e Tel. #& I'2 -�2- 3 7 3 t CIS
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 If using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
$
3 �
Plan Review
$
Fire Surcharge
$
State Surcharge
$
.7
SAC Charge
$
License Surcharge
$
5. 0 0
Curb Cut Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge
$
Tp Ike,51- ,j�/ G°e-
e
TOT}�L
$ Zq
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 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 [ ]
STIPULATIONS: