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PRE 2010 DOCS
City of Fridley SUBJECT 011 AT THE TOP OF THE TWINS BUILDING PERM 121 r NO. COMMUNITY DEVELOPMENT DIV. y r PROTECTIVE INSPECTION SEC. 1 i � 1IL i "1 CITY HALL FRI,DLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L"" A., ,'J 512-560-3450 910-F15 11/8/78 JOB ADDRESS 1311 - 52nd Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 1 Marion Hills 2nd Addition SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Beverly Mattson 1625 - 3rd Avenue South., Anoka. 427-5529 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS WIRQM�NO. HEATING, PLUMBING 6 USE OF BUILDING Residential 7 CLASS OF WORK Ck NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 6 DESCRIBE WORK Construct a 2U 26' x 28' Dwelling and a 26' x 28 Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side yards. Provide a verifying survey before capping. Variance approved for front yard setback. SEWER LOCATION: 19.5' E. of Manhole (E. Inv. 942.00) WYE ELEVATION: 947.85 'IOP OF FOOTING: 950.85 Minimum WATER LOCATION: 10.2' E. of Sewer Service, 50.7' West Northwest of San. M.H. DRIVEWAY DEPRESSION COST: N/A INARHf IhE CITY OF FRIDLEY DOES NOT ,� More diggin'g call ACCURACY OF UTILITY NDAREALEVA7 LOCATIONS TMIS DATA j TELEPHONE ELECTRIC aIGAS I FOR INFORMATION PURPOSES PERSONS SI ONLY AN,) G R SHOULD VERIFY THE INFORMATION REQUIRED ON THE SITE, M BY TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Wood Frame 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 $42,800 $21.40 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION ANY OTHE S TE OR LOCAL LAW REGULATING CON- PERMIT FEE $108.16 SAC CHARGE $400.00 STR CT R THE PERFO M ONSTRUCTION. ^� X/ PLAN CHECK FEE TOTALFEE $ 27.04 $556.60 SIG ATUREOFCON ACTO AUTHORIZED AGENT (DATE) PROPERLY VALIDATED IS YOUR PERMIT 7WHEN �THIS INSP DAT SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE) --jBLDG es V 7�_rw_ L oh -.� � - o ff► Supli *toy, per' ova ' �� oval ' •$� :. wool/ 0 fso4Z / - . I� - ...n � D j,o to 7. - - P8 No z I.I hV) .. �Z rh z gas 'I i �9I h i+Z 8S 8ZG - 8Z i PLO `LS I hA Z, b bh - 6 Zt) CITY OF FRIDLEY , C APPLICATION FOR RESIDENTIAL BUILDING PEfZMI TS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: BUILDER: l ` Address . j/ 3J -C, Address: • SS3® Tel. No.5- 5 �. No. LOT: CORNER LOT: Street: oS:DAJ A _Q%IJF . BLACK: ADDITION: A G;r� (4-e �✓ � C INSIDE LOT: SETBACK: SIDEYARDS: Applicant attach 'to this form T`vo Certificates of Survey of Lot and proposed • building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: Front: U Depth: Height: o20 Square Feet: Cubic Feet: NO Front: Depth: Height:.] • Square Feet: Cubic Feet: Type of Construction: sfi Cost: $ To Be Completed: � � C It. A Alt. B Proposed Driveway Width If New n•ng Is Desired _ $ (SE E 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 �tated.in this application axe true and correct. See reverse si4or addiinformation. DATE: //- 2 •- -7e SIGNATURE Stipulations: Kt,ft .r S� ick$. I , .2ri.o 4 L�oo.ab - 0, CITY, OF $UILDI%G DEPA RTMp.N'T EXT11I0R�"Z'1'0'5i',►D '' tGZ U COMPUTATION (To be -Submitted with building permit application) One or two family dwelling )I Owner All other Contractor Site address 7hons LINEAL FT. OF EXPOSED t, ft. above grade TOTAL EXPOSED WAMAREA SQ. FT. OPAQUE WALT. CONSTRUCTION;"U" value x area � Ft%A'1At w��, Fl��..."U" ��^�� xS q . f t . `, a-��`1. �� � ?. � � _......x { U ) (A ) I'a "'U"..,... --.--... (1.4 (U) (A i ._.:._.. Detail reference k4iIVC. Pte ..r��U" •4�' x sr� . 2-•'�:k AU" x sq. f t. 1,44. �......`. ."`(U) (A) fZ... ?�." 11, 1 (U)(A) f f rom attached sheets "U" x sa . x sq. i e.. .. ft..00 (U (A) "U" flu",x SI. ('UI(A) �. (U)(A) "U" x s q • ft. � (U) (A ) ou" x sq. ,,..,�.._ _ ft. - (U)(A) WINDOWS: "U" value x area Make & type x sq. ft. 6 (U)(A) w w NU« x sq.. ft. (U)(A) U x sq. ft. .. U" r U s sq . ft. • (U)(A) "U" x sq. x sq. ft. ft. (U)(A) (U)(A) DOORS: "U" value x area Make k type `(4,5.r:1..�"U" ,55, x sq. ft.- (U) (A) w w wnw t sq, ft. (U)(A) " w sq. (U)(A) muw . Z ft. (U)(A) TOTAL (U)(A) VALUES t��8 4e TOTALS 0_16"'+ Sq. ft. 19,1-6t (U)(A) DIVIDED BY TOTAL WALL AREA R AGE "U".11 or less " for 1 J2 faai ly dwellings �. .X3 or less r for all other buildings ROOF /CEILING: TOTAL AREA: r 3", Detail sq. ft. reference OUR �. U s sq. from W,4._v&r -."" u ,A x .sq It. . tt t _... =U)(A) JU)(A) !attached sheets* wun _.x Describe openings txP. 4.. Pfr�, �- �U ---r-`=----= sq. ft. tt. � d w;+.. (U)(A) In nef. U x sq. :(U) rt do (A) (U)(A) TOTAL (U)(A) VALUES � � TOTALS { a Sq. ft..., 1-01 AVU '"Uw "---- (U)(A) DIVIDED BY TOTAL ROOF/ CEILING ��"' ^� l AREA A YGRAYE "" s U .� for ventilated roof 91 04 for all other construction A °i !4 suv - -�4?+ L'1 p FIG. #1 PLAN VIEW FIG, #_I SECTION - SECTION 4 7:7 5. R:% ;ZV "V 6. Exterior air film OjZ' V TOTAL (R) flues t 0. N w: nrA Z4 1. Interior NOTE: USE 12% OF OPA OB WALL AREA FOR, 2. Vzl gSwAo. )9 FRAM CONSTRUCTIONXR gMTRuCTION VAt 'ro egooj_C�p rg J, 44*0 Admerr1r-4 Interior air film 5. 6. Exterior I TOTAL (R), 3 d p FIG. #1 PLAN VIEW FIG, #_I SECTION - SECTION 4 11U"- IIR=.doevy 5. &AX 6. Exterior air film OjZ' 2. TOTAL (R) flues 4 . lir so elp"f-F-A.- 1. Interior air film 2. Vzl gSwAo. )9 3 5*,b 'ro egooj_C�p rg MO.' 44*0 Admerr1r-4 5. 6. Exterior air film TOTAL (R), 0401 ti FIG. #1 lote*for air ,1110, COMB. "U" 12 X +(.so I Lxtgri Mew *Ajo� TOUL 1 2 3 4 5 6 11U"- IIR=.doevy &AX 1. Interior air film 2. 3. 4 . lir so elp"f-F-A.- 5 6. Exterior air M; TOTAL Ile• /Rm I. lote*for air ,1110, Lxtgri TOUL IF 'NC�` 7�"'�'.,t' r ,s iii i,�• " "' w � ah;) >� .t ;^ �k rnr rag >< � i #°*,,� G4�% �N ;•rq,� � n7. � � `3 + .�� � ,. - r �•r � r as,y,'q�.-+t ,��,�� aye w^��'7 J 4F' t. �'? ;',•. 1 p Sr .n ° xr� . i7 + I yaSa f •(M y.�':. `y+. r+ iw �+ ' {,• 4 I Cl[ rF a'. N-, r 9 , " ',i 'Y '. tr- t, � ��� rd e1 �� t x>W'k tr r7 '-y 1 u,,�,, '� ti A•. IIy�',�s�,y�� t y a " � ,,.E i a'v%r r ,r_y L , s y . !".�. �F.*,�/"✓!t► t �j �►�v. z / iN • , A + y '• it Fiji t..,;} r Y i. t •� t t" I n ffi A -'vp / 4.: __l Mbs yyy� t ' ' i)ig�1Aw �Vi"'J';, �'' ,}�►! iL�`11�' ,�.�1 d f. �41M y Sy}y r+ a C`/7 QQty►. * [[yp- �•� h ,q.. -. gg AI r .� ] ? (r3 ,, rY 9ry 1. • �LiM�f •i�L 1. d, _ 1 ©_?ry J.r.iY k !► i r y g air filim y s t 4a�ti tii s . pp . lW 60 74" tw> 47♦ •U •y �;J,E /1 /tQ .� x - tJ ISR , lr►+ ,� + yU y s �, ��y, �f � ) �• 'U` •.rr i it El aspps ', 1� �tf , i v �+ y P u' 3 • / . �l ¢o 1,4 ,a'k.><a ,ak ;q�t, ,vw+Jwa .� c r • P= I + tri rz i �/� O.'IF'� (Ax) rix 4 Lrvr .4'Vw� 4! F�:i�rl{' �n R� 1 Ae9' e. r/,L�►� r �'� A� �•6 r r ^ r} Y Jy5 ;Wr'w 1P. r+ MI •��. ai a $Gngv j'�d erCOMB. x r t 1 ,�x(.12 'K . ✓�%: )+(� X�fr}/ky�.: �;' ,�••', r� Y ? xi.'r`ir m? 2 �`�''41F7i r: '++•e:. 'tiEE }� ,, Interior air film. � UAL far f !r4+�. y �' 2 r"y sa,'CY._. �•' 2• fE t '� .?�k pi+ yt, • sr�i� A • Y • i�baR/ �j -!ra . A I 6.' r �� . �w� air TDIVAll MI ) I _ �i�*1� Q i i C ' Y, 't IIS -N: i' Y R _ V /R- Interior R- • ® I h - e + ��'rt 1 i 1 +H ,`s 7 x�r� ti' r 7• ' , ",' 1 • Interior air m ^ y 3 f, a, arYT4 �" 1 1'E fir'►' �* f°y` �y:��I 14 W • ��` c 'rC� � ;_•i..,.,.�� *A IT �'7k t�'' i J✓'"`' 1i i,, : f' .� �7 t' d �-4, €� � :•' , "t S, at fi,a �, agy'ir �! r-„1 - Ttir•jr)� {t• 'F71 SUTION n�J '�i�l � •�aF. *; s' ; , e T ,�� z'-y-'4,�5ta >•y�,fY” g Fa �i}. 9 t +r qI SIr+aY 41;01,� IA pt 1 kY i� Y � i ...� •, �+ R y, t, ' - � � 'ki t f r `"1E 4 J � 1 � ¢'ria,rA�';�, �.%r�� y" +�„ a p.• y. q + G c � S < a. � #i"ri J* +d� `�.I�.y< ay�'ty? � 't q n i ��{ a •, d c ale ��`S .,L 1.� �� :p. �',e�' JZ)�"'.�;. Ai.♦ 4 !�^.r. AliY� .L'�Q. 1 ' wt�4n'� Lrat' w 3• F. �,iOr r- i� # w �' r•- + r i irA�'i S• ,v F,..p. } � J,,. ,� .r•.- rh 4+ir�4 t4i +r �' �y`c � j�Xi TOM', n i t � � y � '� a � �:��. Ate• P k - � •F� "rr r � a w �. y,�!' .. . t _ '•V�� "} ,err t i�•4 �,�4 �. � r +� y / tl�• �'c✓ l � � k„MaE I., y ' ++; o r ?y*y� '$g x 7 e,�,'^' Q " f w e y h�� a ) J:t � ``, r ��{{•}■.y{,�, ° I t/� w �; r`> � �. r✓� a+ „ �Yt� �'�i�,� � i y'�'� xl��; 7 �� ���`�1 �J i {I /�'{.;V• A �'e �Y'� t � � i f?�� � � h�y'� �h Y�f; K3 *. r ' �'(',i.. �ku �r �'� _!t.� 9���� � r -, "• y � y � S i .� I' `1 � . ,y. `� w; t S �',,, ,:. '�� / 1m� � 4 t{ �• i 9b� �.r',r;,' i,, �# s E._ l+l +�;t'• ,, ,.I ,'e# F• :,i ,z a „ r,r " �'^7. " i k. ° ,'',,, ��_: 'x� _ ,. 1., .f,', .-. °,�'�`pAc�• tih r a {'Rr •.t Sr ' ,�. ... E, .. 'r;i� c',f?i b,. ; rP. ;r- v« Xi ;'.3• +, A ., uta FS.7n$t WALL SECTION .r?IIS T'y G' /C /NG• NOTE: USE 12% OF OPAQUE WALL AREA FOR FRAME CONSTRUCTION CONSTRUCTION FIG. #18 PLAN VIEW FIG. #1*6 SECTION ✓ FIG. 02 SECTION FIG. �1�3� SECS t' 4 FA)�4 f 44 PAGE` .; Cl (R) VALUE a . 1. Interior air film 0..68 ` 4. 5. 6. air- - film /Alrwo) dcft TOTAL (R) fluff= 1/R= , /6Z 1. Interior air film 0.68 3.�%►� �t4�t 6il�i� /!vim 4. 5. 6. -finaeodow air f ilm /Vick2_ TOTAL (R) "U"=1 / R= , O7`f F12. #11 COMB. 'U"=(.12 X . Ito )+(.88 X-- AW—) _ , 0 -ss 1. Interior air film 8 ` 2. 3. 4. 5. 6. Exterior air film "U"= TOTAL (R) -� •y'. 1 /R= 1. Interior air film_ 2. 3. 4. 5. 6. Exterior air film TOTAL (R) r y A4 }y4 + 1. Interior air film. 2. 3. Exterior air film B I TOTAL (R)� a° nU" =1/Ra 4 r;s � .' � !"t a .+ ,]! s- � + ,i lsky��.yr ae �� 9 v �` � •r in �' ,4 I YS��ti �rY �','.• � l t x .ci i,� �� }x '���A $ ; F fi - Y y�'Y} wr ,I tiTj1 Y l r f _ � N v s 4, ,"•Mii ,-i �,� r iw$.� 4r F"� 7 � $ 0 1 •. - ,x �' >ar � r tf ',:� t J: -: ! 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'. ea:_•il �.s. �i s.u�„�5et ,�:.`9_-: v +�. n Ya`. ..•++i,. ti' a .'.iia -r5 n._!S':'b��'i�i-,'�3.1"k`i�.�+'�thir$e.f CITY OF FRIDLEY 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 $12.00 $ Replacement of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $ Repairs & Alterations each add. $500.00 4.00 $ MECHANICAL WARM AIR: $ Furnace Shell & Duct Work to 100,000 BTU $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 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 GAS BURNER- from 100,000 BTU to 199,999 BTU (over 199,999 BTU see Fee Schedule) GAS FITTING FEES: let 3 Fixtures Additional Fixtures Gas Range to 199,000 BTU AIR CONDITIONING FAN HEATING SYSTEMS See Fee Schedule VENTILATI ALTERATIONS $ REPAIRS ROUGH INSP. Date FINAL INSP. APPROVAL FOR PERMIT $12.00 $ 4.00 $ 7.00 $ 6.00 $ $10.00 S 10.00 $ $10.00 $ 16f $ x $ 3.00 $�©�. X $ 1.00 $ X $10.00 $ State Surcharge TOTAL FEE REINSPECTION FEE ($10.00) 60 1 MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE Job Address 130 — 15 - Department 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. [41M_Lol� KIND C Fridley, Minn. 10 e 1�r , 19 7v USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. . DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Name ✓ \ 1- Size No. i Capacity Sq. Ft. EDR BTU J ®i7�DQ� HP Total Connected Load Kind of Fuel 1x040 r u BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company Signed By Tel. No. �% S 7 MEMO TO: File MEMO FROM: Richard.N. Sobiech, Public Works Director MEMO DATE: June 12, 1979 SUBJECT: Effecting Lots 1 through 4, Block 1 Marian Hills 2nd Addition Please be advised that the referenced properties are adjacent to an existing sanitary sewer line. Due to the topography of the lots in relation to how single family dwellings would-be constructed, the manholes tend to stick out of the ground quite a distance. It was initially discussed with the property owners from DeGardner Realty, that the City would have -no objection to lowering the man- holes; however, at the property owners' expense. On June 11, 1979, contact with -the property owners indicated that they do not intend to lower the manholes. They, instead, -will provide landscaping to screen the structures. t This information is for the file to advise future property owners I. as to why the manholes are as high as they are.. RNS:ik cc: 1345 - 52nd -Avenue 1335 - 52nd Avenue 1315 - 52nd Avenue 1311 -.52nd Avenue 1307 - 52nd Avenue v 01 SUBJECT City of Fridley 2 3 4 1 8 AT THE TOP OF THE TWINS BUILDING P E R M I T CEIPT NO. Ir? � • COMMUNITY DEVELOPMENT DIV. ______ r 1 ti PROTECTIVE INSPECTION SEC Q 4 1 i NUMBER REV DATEPAGE OF APPROVED By CITY HALL FRIDLEY 55432 ------ �'J 612-571-3450 910-F15 5/31/95 JOB ADDRESS 1311 52 Avenue NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 Marion Hills 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Frank Stokes 1311 52 Avenue NE 572-2280 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 ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (18 Sq) Tear -off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must 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 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 1 HAVE READ AND EXAMINED THIS APPLICATION 1 1 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 $1,350 $.68 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 $33.00 Fire SC $1.35 PLAN CHECK FEE TOTAL FEE 35.03 SIGN TORE OF CONTRALTO R AU RiZED AGENT iDATEi yyy THIS IS YOUR PERMIT �PERLVALIDATED S�GNA R OF NN iy NER U LDE iDATEi g G i P �l�E v 01 NEW [ ] Effective 1/1/95 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Legal Description: Owner Name & Address: Contractor: Address: Tel. # S - -Z-,?, � T w t MN LICENSE # 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 GARAGE AREA: Length Width Height DECK AREA: Length Width Hgt/Ground OTHER: F �� o F r /low E 9` s� Comer Lot [ ] Inside Lot [ ] Type of Construction: Approx. Completion Date: _ Ft. Yd Setback Side Yard Setbacks Estimated Cost: $ Sq. Ft. Sq. Ft. Sq. Ft. STIPULATIONS: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft $ _ $ DATE: ;3 �S- APPLICANT: Tel. CITY USE ONLY Permit Fee $ ��• Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $850 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: