PRE 2010 DOCSCity of Fridley, Minna
BUILDING PERMIT
,4/9,-A)- 1!� re:2
N9 1045
per• Alan Rolland Builder Gerald L. Clark Bui 1 pis
Address 7704 Lake View Lane Address 1271 Arbor qtr _P rC=stal_Ra;,_Minn.
Minneapolis, Minnesota
LOCATION OF BUILDING
No. 188 _Street _71st Way N.E. _ _ Part of Lot
Lot _ _ _2_ __ _ _ Block 1 Addition or Sub -Division . Marri on TP—n —
Corner Lot ` Inside Lot — X Setback —_ Sideyard
Sewer Elevation
To be Used as:
Foundation Elevation
DESCRIPTION OF BUILDING
DwelI ing_ Front 55'-5 5 Depth _2$'__ Height _20..1_ _ Sq. Ft _11081_ Cu. Ft. 22T160
Garage Front 941-5." Depth 9-41 _ Height _10' , Sq. Ft. _558_'_ Cu. Ft. 5880''
Type of Construction 1i':caatia Est. Cost _..._.�1, 00.0 To be Completed Der- 15, 3969
SEWER LOCATION: No services, saddle and tap.
WATER LOCATION: No services, saddle and tap.
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 sOCAorth andimp ce wi all provisions of
ordinances of the city of Fridley.
0
$100.00 Sewer Connection Charge
In consideration of the payment of a fee of $ 42.00 ., 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 andmoving 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. y
'J" ,.�� IL')'J ding Inspector
HANK MUNICH A, y
NOTICE:
" permit don not cover the construction, hwtaliation for wiring, plumbing, gas heNteg, ager or water. Be sme to as
the Building hupector for separate pwmhs for thea hems.
r '*
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME�
ADDRESS
ADDRESS /X12/ <;7 7-,
LOCATION OFBUILDING
No. STREET 7 L/
LOT BLOCK ADDITION OR SUBDIVISION
CORNER LOT INSIDE LOT X , SETBACK 35' SIDL-fARD
SEWER ELEVATION
TOP OF FOOTING
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:
') P% I
Front Is �_ Is Depth Height C< U
Square feet Cubic Feet
Front -2 Ll Depth _2 L4 Height
Square feet Cubic Feet -Mp, SVC
Type of Construction Estimated Cost �/
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 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
.(Schedule of Fee Costs can be found on the Reverse Side.)
" " )
2
2- 2- C, C
September 29, 1969
Village of Fridley 0
To Whom It May Concern:
Because we are living in temporary housing, and very
pressed for time, I would like permission to put in'the
footings, basement and fill for my home to be located at
black 1.
Marion's Terrace, Lot 2,kFridley, Minn. However, I fully
understand that I can go no further until the hard-shells
have been filed and recorded with the Village of Fridley
and Anoka County.
Thank you for your consideration to my request.
Sincerly,
,�OA4 g&4
Allan I Rolland
7704 Lakeview Lane
Minneapolis, Minn. 55432
r �-
,e (o -x,
r �►
SOIL ENG/NEER/NG SER W CES, INC.
6800 S. COUNTY RD 18 MINNEAPOLIS, MINN. • PHONE 941-5600
MAILING ADDRESS
P.O. BOX 35108
MPLS, MINN. 55435
October 14, 1969
Mr. Allan Rolland
7704 Lakeview Lane
Minneapolis, Minnesota 55432
Re: 69-350 COMPACTION TESTS
House at 188 - 71 st Way
Fridley, Minnesota
Mr. Rolland:
As you requested, compaction tests have been taken for the purpose of evaluating the density
achieved in the fill being placed for support of the proposed house at the above referenced
address.
The tests were taken October 13, 1969. At that time, all of the fill was inp lace so that we
were not able to inspect the bottom of the excavation nor determine the depth of fill and required
oversizing.
Compaction tests on the fill encountered a brown fine to medium loamy sand. A modified
Proctor test was run on this material in accordance with ASTM D -1557-66T ( Method A )
procedures.
OUR LETTERS AND REPORTS ARE FO CLUSIVE USE OF THE CLIENT TO WHOM THEY ARE ADDRESSED, A IR COMMUNICATION TO ANY OTHERS,
OR PUBLICATION OF STATEMENTS. C IONS, OR EXTRACTS FROM OR REGARDING OUR REPORTS IS RE , PENDING OUR WRITTEN APPROVAL.
• BORINGS • TES.S • INSPECTION • ANALYSIS • REPORTS - RECOMMENDATIONS
69-350
Mr. Allan Rolland -2- 10/14/69
Compaction test locations were referenced to the approximate building corners. Surface
elevations were referenced to an assumed bench mark; the top of a hydrant at the adjacent
street corner, which was assumed as elevation 100.0.
RESULTS
Results of the modified Proctor test and the compaction tests taken on the fill are shown on
the attached tabulation.
The modified Proctor test indicated a maximum dry density of 129.4 pounds per cubic foot
(pcf) at a corresponding optimum moisture content of 9.2 percent. The two compaction tests
taken on the fill indicated dry densities ranging from 94 to 96 percent of the maximum dry
density.
REMARKS
The results of the two compaction tests indicate that the fill would be adequate for the support
of the typical house loadings on the normal, minimum -width footings.
It should be noted that we were not requested to inspect the bottom of the excavation or to take
compaction tests in the lower portions of the fill. Therefore, we cannot warrant the adequacy
of these soils conditions. Also, penetration test borings to determine the bearing capacity
of the underlying soils were not authorized so we cannot warrant the adequacy of the underlying
soils for the loadings imposed by the fill and the proposed house.
If we can be of further assistance in evaluating these data, kindly contact us at your
convenience.
Very truly yours,
SOIL ENGINEERING SERVICES, INC.
Cameron G. Kruse, P. E.
��..�ai Engineer
7. S raun, P.E.
Soils Engineer
CGK/JSB:js
SOIL ENGINEERING SERVICES, INC.
__� _!
69-350
COMPACTION TEST RESULTS
Test #
1
2
Date
10'/13/69
10/13
Project
Proposed House
at
129.4
188 - 71st Way,
Fridley, Minnesota
Location:
12' W &
12' E &
10' S of
10' S of
NE Corner
NW Corner
Elevation:*
94.5
94.5
Depth Below Existing Grade:
3/4'
1'
U.S. Bureau of Soils Class.
Fine to Medium
Loamy Sand
Field Density Determination: ASTM:D2167-66 (-#4 Sieve Basis)
Dry Density (pcf) 122.6 124.7
Moisture Content, % 10.1 10.8
+#4 Sieve Material, % neg. neg.
Laboratory
Moisture -Density
Determination:
ASTM:D1557-66T (Method A)
Maximum
Dry Density (pcf)
129.4
129.4
Optimum
Moisture Content,
% 9.2
9.2
RESULTS
Relative Compaction
94
*Surface elevations referenced to top of hydrant at adjacent street
corner; elevation assumed = 100.0.
APplIcafflen for Pourer P[urts and Hentlag. Cooling. Ventilation. Re%igee n and
Air Conditioning Systems -and Devices
PARTIAL RATE SCHEDULE
GllAvdTY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ........................... $10.00 $
Replacement of Furnace .............................. 6.00 $
Repairs & Alterations—up to $500.00 .................. 6.00 $
Repairs & Alterations each add. $500.00 ............... 3.00 $
MECH. WARM AIR ' 0 CJ
Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $
each add. 60,000 STU ....................... 3.00 $
Replacement of Furnace ............................. 6.00 $
Repairs & Alterations—up to $500.00 ................. 6.00 $
Repairs & Alterations each add. $500.00 .............. 9.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam .. .$10.00 $
Furnace Shell & Line—to 640 sq. ft. IDR Hot Water .. 10.00 $
Each add. 200 sq. ft. EDR Steam ...................... 3.00 ' $
Each add. 320 sq. ft. IDR Hot Water ........ 3.00 $
OIL BURNER—to 3 gal. per hour ... .:... ... .. 6.00 $
over 3 gal. per hour—See Fee Schedule
pG
GAS BURNER (up to 199,000 BTU) ....................... SAO $L_
over 199,000 BTU See. Fee Schedule
GAS FITTING FEES: NO RATE TOTAL
O �
1st 3 Fixtures ..... ................ x$ 2.00 $ ig
Additional Fixtures ................. x .75 $
Gas Range to 199,t100r ........... s$ 800 $
AIR CONDITIONING
FAN HEATING SYSTEM See Fee Sehedab
VENTILATING SYSTEM
ALTERATIONS& AEPAMB TOTAL FES $/7,
ROUGH
Dept. of Bldga. Phone 880-3480
/ ___ti L(�
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.
Kind of Building,
Used as a1
To be completed about — F_e.j, — l 1 / ! 6 q
Estimated Cost, $ 7 ®, °
Old—New. Building Permit No. Permit No.
DESCRIPTION OF WORK
HEATING or POWER PLANTS --.Steam, Hot Water, jj arm Aird -No
pmG
Trade Name Size No 13-71
F
Capacity Sq. E.D R. / o ® BTU H.P.
Total Connected Load Hind of Fuc
BURNER —Trade Nam Size No
FINAL
(ROMRUS—OVER)
Ft. EMR- BTU H.P.
1 tl��Z�Z4 -,A
By &ArjUA
m
ML mipp-mm�
m
nn NAT WRITE
1
Nmhe of Room
Entire House 1
2 41 vt � -
3 � �
4 �/�
5 ,
2
Running Ft Exposed Wall
AS it
I
3
Room Dimensions, Ft
4
Ceiling Ht, Ft
Directions Room Faces
TYPE
OF
EXPOSURE
Const.
HTM
Area
or
Length
Btuh Area
or
Htg Clg Length
Btuh
Area
or
Length
Btuh
Area
or
Length
Btuh
Area
or
Length
Btuh
Area
or
Length
Bt
Htg
Clg
Htg
Clg
Htg
Clg
Htg
Clg
Htg
I Clg
Htg
5
Gross
a
p o
Exposed
b
Walls and
c
Partitions
6
Windows
a a- c
and Glass
b�- f
r
70
70
/06o0
Doors(Htg)
c
7
Windows
North
and Glass
E &W or NE & NW
Doors (Clg)
South or SE & SW
8
Other Doors
,
o
9
Net
a + ! P
! 3
^
Exposed
b _
S
Walls and
c
Partitions
d c>I
7
10
Ceilings
a ) 1
,�
I
! �� 7
3 l q 7
1
,7 M
591
.J
/ J'
%
I
o sv
10,b
11
Floors a
7
ISS
Y7 4
b
12
Ventilation
a -L
s
5"
% d9v
13
Sub Total Btuh Loss
'if.
K
q0
7,J
14
Duct Btuh Loss
15
Total Btuh Loss
16
People @ 300 and Appliances 1200
17
Sensible Btuh Gain (Structure)
18
Duct Btuh Gain
19
Sum of Lines 17 and 18 (Clg)
20
Total Btuh Gain (Line 19 x 1.3) 1.3
21
Btuh for Air Quantities
Original . .
PERMIT for Power ants and Heating, Cool-
ing, Ventilation, Refrigeration and Air
Conditioning Systems and Devices
DESCRIPTION OF WORK
No. of �p� Heating Plants Wa-IIiris QAJ to be Ij j—altered—repaired
Make
Oil fired ; Coal frred ; Gas fired ; Gas Authorization No.
Remarks � p �i (-Aj0-kk
Approved
Final Inspection Date , 19_
,Inspector
Permit NA
Fee $ 1'7 00
4636
Office of the Inspector of Buildings
City of Fridley
City of Fridley, Minn., 1 J�-a' I
Owner �9LL40 4?o L�Loi4 JJ1
Location A& � �/ ft U),4
Kind of Building AeAM
How Occupied b W LLU iU C,
Work to be Commenced—, 19—
To be Completed_-. ,19
Estimated Cost, $ 20, O 0 Q
Old -New, Building Permit No
Permission is hereby granted to 11 kt0-"-' 7 to install—erect—use the material and devices described in the
above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work
done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley
relating to or governing the work to be done and the operation of the devices herein named, and to the specificatio s=thhe approved application for this
permit on ftle in the office j'ice o f the Inspector of Buildings.
Inspector of Buildings
42 2Ml147V
Original Permit for PLUMBING AND GAS MTING
N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for
inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit.,
DFSCREMON OF WORK
Number, Sind and Location of Fixtures
Stories
m
W
�g
U
m
'C
z
►z.m
m F
m
m
m
z
'm
aY
3
F'
Z'
o IL
m
W
o
G' m
°oz
a
= m
5'm
m
z�
z°
mx
i
ma
o a
d
mzQ°
n K
WATER HTR.
ass
ELEC.
Basement
1st
/
2nd
3rd
4th
Connected with(Se a Cesspool Gas Piping for Openings
Permission is hereby granted to do the plumbing and
gas fitting in the building described in &e statement hereto attached,n the express condition that
the person to whom this permit is granted, and his agents, employees a workmen, in the plumbing
or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and
this permit may be revoked at any time upon the violation of any of the provisions of said ordinances.
By Order Of The Inspector Of Buildings
Roughing in Inspection Date
Inspector.
Final Inspection Date F
N? 5060
/-/ "-Iea 6
Fee Pr'J/ 15-
City of Fridley L E Q ,19LI
Owner AL Rb L A &)-b
Location f 000 -- % 14 -1 --
Kind of Building FOQ A (h E,
Used as D A) LLL I 11� CA
To be Completed rA , 192Q
Estimated Cost $ �' � 00
O -New. Building Permit
Date
Inspector. Inspector of Buildings.
•� 1M—bb9-V
Clay of Fridley
Approcaflon for and G= Fisting Perm*
Dept. of Bldgs. Phone 360-3430
DESCRIPTION OF WORK
}` Number. Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RA
Number Fixtures i% x $2.00
Future Fixture Opening x $1.50
New Fixture Old Opening x $1.50
Catch Basin
Water Heater (Up to 99,000 BTU)
New Ground Run Old Bldg.
Electric Water Heater
GAS FITTING FEES:
1st 3 Fixtures .....
TE TOTAL
$ � . 6
$
x $3.25 $
x $3.00
x $3.25 $
x $2.00 S.
NO. RATE TOTAL
/ x $2..
Additional Fixtures .............. x $ .75 $
Gas Range to 199,000 BTU .............. x $5.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description .... ...........$
TOTAL PLE $ 0
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.
Owner
Kind of Building ��v•
Used as
To be completed about 14 Z4--'
Estimated Cost, $_�� ��� 0
Old New. wilding Permit No.—_ _ _Pena! N *�5,1 bu (o
Signed
By- - -
Business Phone No
ROUGH
FINAL
N
N
(7
Z
n
c�0
•
/
•
N
WATER HTR.
GAS
ELEC.
Base
®
1
_
1st
c;2�-
2nd
3rd
4th _
' Future Connection Openings Connected with
e New Fixture, Old Openings I fie?
Cesspool ❑
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RA
Number Fixtures i% x $2.00
Future Fixture Opening x $1.50
New Fixture Old Opening x $1.50
Catch Basin
Water Heater (Up to 99,000 BTU)
New Ground Run Old Bldg.
Electric Water Heater
GAS FITTING FEES:
1st 3 Fixtures .....
TE TOTAL
$ � . 6
$
x $3.25 $
x $3.00
x $3.25 $
x $2.00 S.
NO. RATE TOTAL
/ x $2..
Additional Fixtures .............. x $ .75 $
Gas Range to 199,000 BTU .............. x $5.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description .... ...........$
TOTAL PLE $ 0
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.
Owner
Kind of Building ��v•
Used as
To be completed about 14 Z4--'
Estimated Cost, $_�� ��� 0
Old New. wilding Permit No.—_ _ _Pena! N *�5,1 bu (o
Signed
By- - -
Business Phone No
ROUGH
FINAL
City of Fridley
Application for Pin■dxbg and Gas Fhfing Pomb
Dept. of JUgs. Phone 90-3450
DESCRIPTION OF WORE Leese % Vg —71
Number. Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ................ x $2.00 $
Future Fixture Opening ............ x $1.50 $ _
New Fixture Old Opening .......... x $1.50 $
Catch Basin .................... x $3.25 $
Water Heater (Up to 88,000 BTU) .... x $3.00 $
New Ground Run Old Bldg......... x $3.25 $
Electric Water heater .............. a $2.00 $
:;AS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures ....... • .. • ..... x $2.00 $
Additional Fixtures .................. x $ .75 $
Gas Range to 198,000 BTU.............. x $5.00 $
REPAIRS B ALTERATIONfi—Refer to Code
Description ............................................ $
TOTAL FEE $
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 Ci%v 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
dd�
Fridley, Mipp .,921
Owner
Kind of Building
Used as
To be completed about j
Estimated Cost, $ /-/,.3 f
Old—New. Building Permit No. Permit No.�
Signed
By ` --
Business
ROUGH
_
MIMIMMMIMELI
■MMMMMMM
LM ..
■
■
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ................ x $2.00 $
Future Fixture Opening ............ x $1.50 $ _
New Fixture Old Opening .......... x $1.50 $
Catch Basin .................... x $3.25 $
Water Heater (Up to 88,000 BTU) .... x $3.00 $
New Ground Run Old Bldg......... x $3.25 $
Electric Water heater .............. a $2.00 $
:;AS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures ....... • .. • ..... x $2.00 $
Additional Fixtures .................. x $ .75 $
Gas Range to 198,000 BTU.............. x $5.00 $
REPAIRS B ALTERATIONfi—Refer to Code
Description ............................................ $
TOTAL FEE $
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 Ci%v 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
dd�
Fridley, Mipp .,921
Owner
Kind of Building
Used as
To be completed about j
Estimated Cost, $ /-/,.3 f
Old—New. Building Permit No. Permit No.�
Signed
By ` --
Business
ROUGH
SUBJECT
PE
City of Fridley
23576
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
• COMMUNITY DEVELOPMENT DIV.
_
r � PROTECTIVE INSPECTION SEC
�
1 � �
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED By
�-j 612-571-3450
910415
7/25/95
JOB ADDRESS 188 71 Way NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
2
1
Marion Terrace
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Allen Roland 188 71 Way NE
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Midweel<tSiding & Roofing 3533 Perry Ave N, Crystal MN 55422 521-3652 20010277
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 fl
❑ NEW ❑ ADDITION ❑ ALTERATION x REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House (30 Sq) Tear-off
9 CHANGE OF USE FROM 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
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2,250
$1.13
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS 9F ANY OTHE STATE OR LOCAL LAW REGULATING CON.
STRUCTIO THE PERF MANCE
5/{,QQ
Fire SC $2.25
PLAN CHECK FEE
TOTAL FEE
ZCTRUCTION.
...License
SC
5.00
62.38
SIGNATUR OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPER VALID TED THIS IS YOUR PERMIIITT�/y�`/
BLD IN SP
f)A E
SIGNATURE OF OWNER IIF OWNER BUILDERi IDATEI
NEW (( Effective 8/l/95
ADDN (( CITY OF FRIDLEY gi- `/
ALTER (� SINGLE FAMILY AND DUPLEXES R-1 AND R-2 7
Building Permit Application
Construction Address: -7/Sf.��
Legal Description:
Owner Name & Address:Ie o Tel. #
Contractor: �;�wfs-% .Sri%� o�-� —
MN LICENSE # ® o/ d J 7
Address: 3.5-3 3 rIC c G �/ Tel. # SQ/~3GS J
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- ISq. Ft. --
Lenges
Width
Height
Length
Fee Schedule on Reverse Side
Width
fi(') --2"
Hgt/Ground
o"4'2 neL -
Corner Lot [ ] Inside Lot [ ] Ft. Y Setback
Type of Construction: a ®�
Approx. Completion Date:
Sq. Ft.
Sq. Ft.
Side Yard Setbacks
Estimated Cost: $
(Cost on Back)I
Driveway Curb Cut Width Needed: FtA6F = t x $ — $
DATE: _APPLICANT:
i'� Tel. #
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ -
Fee Schedule on Reverse Side
Fire Surcharge
.001 of Permit Valuation (1/10th%)
State Surcharge
$1, Z- $.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 [
0
6-, 30
TOTAL
$ — - --
STIPULATIONS: