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PRE 2010 DOCSSUBJECT PERMIT_ N City of Fridley 4 a AT THE TOP OF THE TWINS BUILDING PERMIT ° COMMUNITY DEVELOPMENT DIV. r,.------- INSPECTION SEC. �ptd r 1 PROTECTIVE � I � -'t CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 9/ 2 4/79 JOB ADDRESS 4744 - 2'k Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 7,8 6 Plymouth Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE M. Lynne 4744 - 2k Street N.E. 560-7448 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Stuart Construction Co. 4611 L ndale Avenue North 529-9661 4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO, 6 USE OF BUILDING Re aidential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X X 8 DESCRIBE WORK Install ramp on back of house and inside remodeling 9 CHANGE OF USE FROM TO STIPULATIONS This plan i_s being approved only after homeowner consents and signs permits because the outside ramp does not meet the 20:1 slope specified. for commercial use for the handicapped. WARNINS Before digging call local uffi lee TELEPHONE - ELECTRIC - GAS Et; SEPERATE PERMITS REQUIRED FOR WIRING, REQUIRED BY ,AIV HEATING, PLUMBING AND SIGNS. 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 $7,000. $3.50 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 ST E OR LOCAL LAW REGULATING CON- $42.00 STR ON OR THE PERFORMA E OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $45.50 fIGFATURVOF CON ACT R R AUTHORIZED AGENT (DATE) WHEN PPOPERQY VALINq, D THIS IS YOUR PERMIT r1 _ rf X 9� ♦�a�� SIGNATURE OF OW Rd OWNE BUILDERi (DATE) BLDG INSP DATE • CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (flew, Alterations, Additions, or Repairs) OWPJER. BUILDER: ko ADDRESS: 7 q4- ie��, h ADDRESS: 7 TEL X10: ,s—G ® -a TEL NO: Construction Location " - STREET NO: 1-7L-7 AN STREET: tom&- IAT: —8 BLOCK: ADDITION: C1C �Z7 Ab 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 F �aS �ront: Depth: ht: - Bei OAi • 8 p g Squane.Feet: Cubic Feet: Front: Depth: Height: Square - Feet: Cubic Feet: Type of construction: /'� . Estimated Cost: $ o oa)"o (:D WD Be Cbmpleted: ' . Alt. A Alt. B . Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET . ..7he 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: � I � SIGNATURE:. J a �\ Stipulations: pp ez co Ohjeke is �05- A Inc rz CW' SCOP �� CITY OF FRIDLEY APPLICATION FOR PWMBING AND GAS FITTING PERMIT ' PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE Number Fixtures 10 - x $3.00 Future Fixture Opening x U New Fixture, Old Opening X d Catch Basin Water $5.00 Water Heater - to 99,000 BTU x $5.00 100,000 BTU to 199,000 BTA x $10.00 r.° .4 i x $7.00 M 0 $4 $5.00 w x $5.00 Beater a M .a c S -A d0 l 0 .i M jMMNy lec o{O 'fat a 1st 2nd ' 3rd 4 th (R) o Future Connection Opening Connected with Sewer (tj a New Fixture, Old Opening Water ' PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE Number Fixtures 10 - x $3.00 Future Fixture Opening x $2.00 New Fixture, Old Opening x $2.00 Catch Basin x $5.00 Water Heater - to 99,000 BTU x $5.00 100,000 BTU to 199,000 BTA x $10.00 Water Softener x $7.00 New Ground Run Old Building x $5.00 Electric Water Heater x $5.00 GAS FITTING FEES: 1st 3 fixtures x $3.00 Additional Fixtures x $1.00 Gas Range to 199,000 BTU x $10.00 REPAIRS & ALTERATIONS First $100.00 $5.00 each add. $100.00 or fraction $2.00 State Surcharge TOTAL FEE REINSPECTION FEE ($10.00) TOTAL Job Address / 7 Y�l 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 Cedes and rulings of the Department of Buildings, and hereby declares that all the facts and roprosontations stated in this application are true and correct Fridley, Mn. _ z6-- . 19� OWNER KIND OF BUILDING USED AS �'�� ✓C —a TO BE COMPLETED ABOUT ESTIMATED COST BUILDING PERMIT NO. PERMIT NO.. Company Signed By Tel. No. — ROUGH INSP. Date FINAL INSP. 3 o a $ Date S $ APPROVAL FOR PERMIT $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCKARGE SUBJECT'P IT N City of Fridley ° 171. 3 AT THE TOP OF THE TWINS BUILDING PERMIT r � ECEIPT N0. • COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. /�--1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 5/13/8 JOB ADDRESS 4744 - 21-2 Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7,8 6 1 Plymouth Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Mary Lynn 4744 - 2-� Street N.E. 572-8924 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Ev's Construction 10931 Kumquat, Coon Rapids 755-2497 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 ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Reroof Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be 2nd layer but not 3rd. Install 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 1 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS I GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,100 $.55 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE -PE RMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $19.00 . RUCTION OR THE PERF RMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE T', xq-1 $19.55 GNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY )DATED THIS IS YOUR P RMIT_ BLDG INSP r1AT SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATION FOti RESIDENTIAL BUILDIRG PERMITS (Rew. Alterations. Additions. or Repairs) OWNER: ADDP.ESS: 71-4 v TEL 110: 7 BUILDER: i:L4 ADDRESS: 16t TEL NO: opt Construction Location • STR= NO: STrd=: LOTt SLOMS ADDITION: Corner Lot: snsiae Lot: _ Setback: Sideyards: A2231cant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF COWSTRUCTION Front: Depths Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic reet: Type of Construction: tl" Estimated Cost: Tb be Cbr.,pleted: Alt. A Alt. 8 Proposed Driveway Width If New opening Is Desired: $ ' $ SEE RzVERSE SIDE OF SHEET Zile undersigned hereby makes application for a permit fer the :fork herein specified, agreeing to OO.all work in strict accordance with the City of Fridley Ordinances and rulings of the Deixixtment of Duildings, and hereby declares that all the facts and representations stated in this applicatio are true and correct. �1TEs S I (WATum Stipulations: `®� X 82-119 S-6 BUILDING EXTERIOR a. Replace all gutters. Use •33' lengths or seamless type gutters. Gutters to be pre- painted type. Use existing down spouts. b. Re -roof over existing one layer. Use 240# 3 tab shingles. Owners choice of color. Boston type ridge & hips. Valleys to be galvanized with'v diverter or laced shingles. Replace broken roof louvers & any rusty plumbing vent jackets. C. Clean existing storm window tracks and spray tracks with silicone to operate smoothly. d. Replace all missing & loose window sash putty.* Paint outside of sash. Clean, stain, seal & varnish inside of all sash. e. Scrape all windows and doors trim & window sills to remove all loose & flaking paint. Prime bare spots and paint. f. Replace broken & missing shakes, prime & paint, color to be similar to present color. g. Remove loose & pealing eave & gable end paint, prime all bare spots. paint similar to present color. .S-7 HEATING AND PLUMBING a. Repair dripping laundry tub faucet, outside sill cocks and install missing handles. b. Replace forced air gas furnace with new Energy efficient gas furnace, include combustion air intake as per code. S-8 GENERAL HEALTH AND SAFETY S-9 ELECTRIC ! ' - a. Repair faulty light switch to basement. Install 3 new pull chain porcelain fixtures / in basement. Install new switch plate on basement bath switch. Install new �/[�1, switch plate at bottom of stairway. Install new ceiling light shade _on NW bedroom CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Residential Rate TOTAL Furnace Shell and Duct Work, Burner — Aiso Replacement Furnace $ 20.00 $ (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) $10.00 $ Gas Range $10.00 $ Gas Dryer $ 10.00 $ *Air Conditioning — All Sizes $10.00 All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/industrial 1% of Value of Appliance or Work State Surcharge TOTAL FEE i� Effective.On January 1, 1993 JOB ADDRESS �1? n7 �/� 5 fL,�,` �l-li "� /f 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 andforsect. BUILDING USED AS / 7, ESTIMATED COST 5�_ PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Unit Circle One (Steam) (Hot Wat ) (Warm Air Trade Name Size No. BTU ( 6rjo HP EDR $ Fuel AS ,- Total Connected Load $50 MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. so Burner Trade Name . Size No. BTU HP EDR HEATING COM Signed By Tei No.%S� 5 2- Approved By' Rough—in Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE NOTE: #1 through #8 required when using a side vent furnace. 6 Has total heating BTU's of All other BTU's TOTAL BTU's T. 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: CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: I . 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 T. 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: NO SUBJECT City of Fridley 448 9 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. I �g � � NUMBER REV DATEPAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/26/96 JOB ADDRESS 4744 2 1/2 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 8 6 1 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mary Lynne 4744 2 1/2 Street NE 572-8924 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO R & M Associates 3482 Auger Ave White Bear Lake MN 55110 770-9322 4391 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 ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE % 8 DESCRIBE WORK Reside dwellin • install windows 9 CHANGE OF USE FROM TO STIPULATIONS Replacement bedroom windows must meet the State Egress Code. Install smoke detectors to 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 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 $4.86 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $9,726 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $162.25 Fire SC $9.73 STRUCTIO,A OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE License C .00 $181.84 SIGNAT EOf VONTRACTORORAUTHORIZED AGENT 1 7 AAN RLY VA TED THIS IS I R P M1 SIGNATURE OF OWNER,IF OWNER BUILDER) IDATEI GATE NO NEW (] Effective 8/1/95 ADDN j ] CITY OF FRIDLEY ALTER j ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Legal Description: — Owner Name & Address: Tel. # Sf7Z — �a / y ti r�v c ZX - Contractor: Rfi / !2:55 0 c-- MN LICENSE # ZX- ` Address: 3 /'5�G a r,- r w 4 G•e, A -f- rs%/o Tel. # '7��- Attach to this application, a Certificate of Survey of the lot,, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT DIVING AREA: Length Width Height Sq. Ft, GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Type of Construction: r, W� ,vdo� 5 5',J Approx. Completion Date: Side Yard Setbacks Estimated Cost: $ (Cost on Back) Driveway Curb Cut Width Needed: _Ft. + 6 Ft = Ft x $ _ $ DATE: _ APPLICANT: t - ate Tel. # -F 3 Lt— CITY USE ONLY CITY Permit Fee $ %�� Fee Schedule on Reverse Side Fire Surcharge .001 of Permit Valuation (1/10th%) State Surcharge $ y, (, $.50/$1,000 Valuation SAC Charge $ $850 per SAC Unit License Surcharge $ S,06 $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Pian Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary j ] TOTAL $ A4' STIPULATIONS: Su&ikT City of Fridley 7 FT1446 AT THE TOP OF THE TWINS BUILDING PERMIT I NO. • COMMUNITY DEVELOPMENT DIV. 1 w ------ INSPECTION SEC. r � I PROTECTIVE CITY HALL FRIDLEY 55432 NUMQER NEv GATE PAGE OF AO�PROvED By 612-571-3450 910-F15 10 /5/00 JOB ADDRESS 4744 2 1/2 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7,8 6 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mary Lynne 4744 2 1/2 Street NE 763-572-8924 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 Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION Gj REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (13 Sq) 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 OCCUPANCYLOAD 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 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 $.66 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,329 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- $50.95 Fire SC $1.33 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK F E FEE TA-94 51 AT VFCONTRACT R AUTN0 ZED AGENT IDA TEI EN PRO ALI AT THIS/IS YOUR PERlM(�I/T �% INSP MATE AGN TURF OF OWNt ROF OWNS BUILDER. Z DATE, NEW I l Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name & Address: Tel. # Contractor: MN LICENSE # Address: Tel. # 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 AREA: Length Width Height Sq. Ft. DECK AREA: LengthWidt Hgt/Ground Sq. Ft. OTHER: Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ S?) %S' Fee Schedule on Reverse Side Fire Surcharge .001 of Permit Valuation (1/10th%) State Surcharge $ 6 6 $.50/$1,000 Valuation SAC Charge $ $1100 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 $_ STIPULATIONS: