PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N? 33?
Date: Aa —
,..rOCATI N OF BUILDING
No. Street --Put o!
Lot _ _ _ Slock Addition or Sub -Division
Corner Lot __ Inside Lot — Setback or Sideyard
Sewer Mention _____ _ Foundation Mention
DESCRIPTION OF BUILDING
TOP Used
t Depth 4 Height Sq. FtylCu. Ft I,w
Fro
Depth --""eight Sq. Ft. r Cu. Ft.
Type of Construction' Fst. C)�O be Completed
rn consideration of the issuance to me of a permit to. construct the building described above 1 agree to do
the proposed work in accordance with the description above set forth and in compliance with a�l provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee ofpew t 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 ordinanoss of
Fridley, Miimesota regarding location, construction, alteration, maintenance, repair• and moving of buildings
within the city ]units and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
NOTICES
Yids p•rmh don not cover the aona mcdon, inshllatien for whhm phnmbino, on heatieo, awnr or water. Be sun to me
the BOA* Mqm ter for aparate pwft for thea hems.
APPLICATION FOR BUILDING PERMIT
CITY OF- FRIDLEY, MINNESOTA
��L//jam (r a vs / '4
OWNER'S ITA149�- C�� BUILDER
ADDRESS 6 �0 I u144116 -u- a -4,-e- S.e ADDRESS
/ L/ LOCATION OF BUILDING
No. '7 Street_, / Part of Lot
Lat Block Addition or Subdivision uc
Corner LotInside Lot Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as:
Front f Depth Height
Sq. Ft. Cu. Ft. �9
Front Depth Height,
Sq. Ft. Cu. Ft.
Type of Construction 4 C'it',y � Estimated Cos ,
m
To be Completed__�Cs16� ,� 3
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_4?— _ StGNATi1RE
(Schedule of Fee Costs can be found on the Reverse Side).
Application for Power Plants and Heating, Cooling, Ventilation, Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ........................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
NECK. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace ............................. 5.00 $
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. IDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
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 $ 1" , I
GAS FITTING FEES:
NO RATE
1st 3 Fixtures .....................
x $1.50
�TOTAL
$—
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 FEE
$
ROUGH
FINAL
Dept. of Bldgs. Phone SII 4-7470
Location Co o� �oC — � �Z ZA
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 and correct. // �
Fridley, Minn- — 07 y, 19 cs�
Owner _
Kind of Building
Used as
To be completed about
D (1 a o
Estimated Cost, $
Old New.) Buildina Permit No. . 3 Permit No.
DESCRIPTION WORK
HEATING or PO PLANTS—Steam. Hot Wa r, Warm Air o —4
Trade Name @tC27CJ Size No X
Capacity Sq. Ft. E.D.R.V BTU H.P.
Total Connected Load a % o / Kind of Fuel
BURNER —Trade Name Size No
Capacity Sq. Ft. E.D.R I BTU H.P.
(REMARKS -OVER)
SignedRAY N. WELTER HEATING CO
4637 CHICAGO AVE.
By MINNEAPOLIS 7. M1NNEF;C3:F*
42 2M Business Phone No`s ✓ ^' � � �Z
City oFridley
Fidle
Y
Application for Plumbing and Cas Fitting Permit
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK � � (/� v �/ 7
Number, Kind and Location of Fixtures Location a
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ....... I I x $1.50 $ ®ed
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 $
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 fael
and representations stated in this application are true and correct.
19_
Owner
Kind of Buildin{g�
Used as �
To be completed about
Estimated Cost, $
&- =) e
Old—New. Building Permit No 4/0' 13 13PermitNo. 71-3
ROUGH
GAS FITTING FEES: NO. RATE TOTAL FINAL-_
1st 3 Fixtures ..........................
e�
Additional Fixtures .................... 1 ��—
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................
TOTAL FEES$ d2 sM
By W.
Business Phone
uN1
Z
�O
,
F
`
N
WATER HTR.
GAS
ELEG
Base
i
ist
2nd
3rd
4th
_
• Future Connection Openings
e New Fixture, ON Openings
Connected with
Sewer C]
Cesspool Ej
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ....... I I x $1.50 $ ®ed
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 $
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 fael
and representations stated in this application are true and correct.
19_
Owner
Kind of Buildin{g�
Used as �
To be completed about
Estimated Cost, $
&- =) e
Old—New. Building Permit No 4/0' 13 13PermitNo. 71-3
ROUGH
GAS FITTING FEES: NO. RATE TOTAL FINAL-_
1st 3 Fixtures ..........................
e�
Additional Fixtures .................... 1 ��—
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................
TOTAL FEES$ d2 sM
By W.
Business Phone
James D. Nelson
10917 Nord Ave. South
Bloomington, MN 55437
To whom it may concern:
I, James D. Nelson, owner of the addressed property of 6242/6244
5th Street, Fridley, MN. give my permission to Marlys K. Rechkemmer,
owner of 6232/6234 5th Street, Fridley, to place a paved parking pad
next to my property line at the above address.
I acknowledge that this work will be approved by the City of Fridley and
begin as soon as possible this Summer.
,
Si ned4, 1 W-,,9 �
James D. Nelson
52-84-5915.51
City of Fridley
Application for Plumbing and Gas Fitting Permit
Dept. of Bldgs. Phone 560-3450
DESCRIPTION OF WORK Location 6212 N E 5th St
Number, Kind and Location of Fixtures
pp
rA
$
x $1.50
$
x $1.50
$
x $3.25
$
x $3.00
!
UW'
Ute'
Z
•
•
WATER HTR.
GAS
ELEG
Base
InE a3 1 qasjDrzBr
Ist
2nd
3rd
4th
• Future Connection Openings
* New Fixture, Old Openings
Connected with
I Sewer �
Cesspool ❑
PARTIAL RATE SCHEDULE
PLUMBING 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 .............. 1
REPAIRS & ALTERATIONS—Refer to Code
x $2.00
s
$
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$.75 $
x $5.00 $ 5•oo
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 1-11-68 19—
Owner Dick Renter
Kind of Building frame
res
Used as
To be completed about 1-17-68
Estimated Cost, $ 10.00
Old—New. Building Permit No Permit o.
Si e
By
Business Phone No
ROUGH
FINAL
Description .................................. .............$
TOTAL F'EE $ 5.00 az
SUBJECT
PERMI-
City of Fridley
2086
AT THE TOP OF THE TWINS
BUILDING PERMIT
-
i
RECEIPT NO.
_ COMMUNITY DEVELOPMENT DIV.
v PROTECTIVE INSPECTION SEC.
�� y
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
6/4/91
JOB ADDRESS 6242-44 5th. Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
4
1
Sandy Terrace SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Ted Shirley 2800 Huntington Ave, St. Louis Park, MN 55416 926-3460
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
Duplex
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION C� REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
Reroof; Structure (20 Squares)
9 CHANGE OF USE FROM TO
STIPULATIONS
RoQf:ing can be the 2nd layer but not the 3rd.
TYPE OF CONST,
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION
2
STALLS 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� 040 $ X52
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$27.00 Fire SC $1.04
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN K FEE TOTAL FEE
.56
SIG RE OFCONTR ROR AUT ORIZEDAGENT ID TE I 1
`' WHE ROPER Y T I is OUR PERMIT
r
X_
INSP SATE
SIGNATURE OF OWNER_ OW R ERI I ATE
NEW [ ]
ADM [ ]
ALTER [ ]
R-1 AND R-2
BuildiM Permit Application
Effective 1/1/91
Clmstn=tian Address:
legal Description: da �' 4dle k
Owner Name & Address: 4'/ / - t e6 4 , Tel. #, 9116 Y Y6 G
Contractor: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
�QiIPTION OF II�ROIVFI�
LTVIM AMM: Iength Width Height Sq. Ft.
GRP -VM AM: length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
ORHER: lee v , -!10 ¢7 :
Oorr-er Lot [ ] Inside Lot
Type of Construction:
Approx. CcMletion Date: _
I
Ft. Yd Setback Side Yard Setbacks
Estimated Cost: $ i C" `I C
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
"Width + 6' See Back Page
DATE: 5` APPLICANT': Tel.. #
Permit Fee $ 60
Fine Surcharge
State Surcharge $ .a
SAC Charge $
Driveway Escrow $
Park Fee $
Sewer Main Charge $
Fee Schedule on Reverse Side
.001 x Permit Valuation (1/10th $)
$.50/$1,000 Valuation
$650 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
ing
Agreement Necessary [ ] Not Necessary [ ]
CITY OF FRIDLEY INSPECTION DIV.
43t University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
Effective On January 1, 1995
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,.
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND'DEVICES
JOB ADDRESS%�,
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 (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1% of Value of Appliance or Work
Rate TOTAL
$ 20.00 $ O'� ® 6
$10.00 $
$10.00 $
$10.00 $
$10.00 $ /e� ao
$
State Surcharge
TOTAL FEE
$60
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
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.
The undersigned hereby makes application for a permit for the work herein
specifiedtagreeing to do all work in strict accordance with the City Codes ar
rulings of the Building Division, and hereby declares that -all the facts and
representations stated in this application are true anq correct.
1995
OWNER O �6 Z
BUILDING USED AS
ESTIMATED COST % ' u PERMIT NO. :
DESCRIPTION OF FURNACE AND•OR BURNER
No. of Heating Units Circle One .(Steam) JH of Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
Fuel Total Connected Load.
Burner Trade Name Size No.
BTU HP EDR
HEATING COMPANY
Signed By Tel No.
Approved By, : - Rough—In Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
, r2f
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 199'
6434 Urfiversky Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,.
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND-'DEVICFZpS�'�1
JOB ADDRESS %.
RATE SCHEDULE
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 (LIST ON BACK)
I% of Value of Appliance or Work
Commercial/Industrial
1 % of Value of Appliance or Work
Rate
$ 20.00
$10.00
$10.00
$10.00
$10.00
State Surcharge
TOTAL FEE
The undersigned hereby makes application for a permit for the work herein
TOTAL specifled'agreeing to do all work in strict accordance with the City Codes ar
too rulings of the Building Division, and hereby declares that all the facts and
$ representationsstated in this application are true correct.
. e a:r"/8
OWNER 14'e711-_ �� � ,!✓ . ��-�.� Z ' � `% .
BUILDING USED AS
MINIMUM FEE FOR ANY HEAT[ NG/COOLINGNENTILATION
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.
ESTIMATED COST _ ...PERMIT N.0. ..LIZ
(�
DESCRIPTION OF. FURNACE AND -OR BURNER
No. of Heating Units Circle One .(Steam) JHot Water) (Warm Air.)
Trade Name Size No.
BTU HP . EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
HEATING COMPANY
Signed By r? - •Tel,No. D-6 7 6J/
ApprovedBy ,r l�' Rough -In Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
lJ
SUBJECT
P
City of Fridley
2
AT THE TOP OF THE TWINS
BUILDING
PERMIT
Ir � ,
T NO.
• ______ COMMUNITY DEVELOPMENT DIV.
r I PROTECTIVE INSPECTION SEC
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
12/26/95
JOB ADDRESS 6242-6244 5 Street NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
1 1
1 Sandy Terrace
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Trent Brod 6443 20 Ave S Richfield MN
55423
866-8829
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Seamless Gutters Inc 2191 1
786-5874 1146
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Duplex
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Soffit/Fascia
9 CHANGE OF USE FROM
TO
STIPULATIONS
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
2
STALLS I 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
$1,824
W 1 , 824
. 91
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.
$57.41
Fire SC $1.82
PLAN CHECK FEE
TOTALFEE
License SC $5.00
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WAIN PROPY&Y
VALIDAPEWTHIS IS YOUR PERMIT
SLOG INSP
GATE
SIGNATURE OF OWNER uF OWNER BUILDERI IDATEI
lJ
CITY OF FRIDLEY TEL: 612-571-1287 Dec 18.95 14:08 No.005 P.01/02
N..W l;ft'c;c:tivc 8/1/91
ADDN [ ] CITY OC 11Rl DLEY �S
AlXF,R [ ; SINGLE FAM11M AND DUPLEXES R-1 AND R -Z
Building Permit Application
construction Address: (D o_t <la -4t- ( a Alf/ r-Jef 0 y
[.egal Description:
o a'`
Owner Name & Address: n4 A) T- 'Q „,Qo o _ �e s, a 440&S0Tel. # 9,9d9
Contractor: -_S AML—ss a&t77-e-es,–r vd _ MN LIChNSti
Address: oZ i q /- l0 6 06 9LN I A)& � Avl a Ss yv 9_ Tel. # IM, - S d
Attach to this application, a Certificate of survey of the
Lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF 1MPROV�NT
LIVING AREA: Length Width Height Sq. Ft.
CARAGA AREA: Length —. Width Height Sq. Ft. _ DECK AREA: Length _ -_-- Width HgU Iround _ Sq. Ft.
DTHER:
:orner Lot j ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
ype of Construction: t NSTa" 4Lurn. S 4,f-7- v F9s e' -,q imdW Cost: $ 14:2
—
.Oprox. Completion Date: / a - Ad- 9.S
(Cost an Back)
rriveway Curb Cut Width Needed: Ft. 4, 6 Ft Ft x $ $
ATF.: _�— APPLICANT: Tel. #
ennit Fee
ire Surcharge
AW Surcharge
kC Charge
icense Surcharge
riveway Escrow
rosion Control
:irk Fee
;wer Main Charge
TOTAL.
rIPULATIONS:
$ . Pa
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$850 per SAC Unit
$5.00 (State Licensed Residential Contractors)
All. "A` or Alt. "R" Above
$450.00 Conservation Plan Rovicw,
Fee Detennined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
r