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PRE 2010 DOCSCity of Fridley $U9�EGT Permit No. 4T THE TOP OF THE TWIN$ L. PLUMBING PERMIT APPLICATION f L-------- COMMUNITY OEVELOMENTDIV, r � I i F*OTECTIVQ I G0VCT*N MPT, • 1 �.-.` CITY WALL FONDLY 0642 .� `I$-600-3460 NtAaM REV. DATE ►AAE OF APPROVED ®Y _UQ__'P0 12/15/73 1 1 800 Job Address -5-:✓7 -5— - 70,_'_1/1, e . ner Ad res Phone Address Phone Plumbing Contract/or �� rF Kind of Builging Use��. Completion Date Estimated Cost�/A II , li Plumbing Fixture Rates: NO. RATE TOTAL I IjI i W -- Ii ----. I! Number Fixtures x $2.00 i " Future Fixtures x $1.50 1 j I a�Nral sVs C4 i New Fixture-Old Open. x $1.50 O Catch, Basin x $3.25 av° I 7CI! I I i j j Water Heater-99,000 BTU x $3.00 :!3, eO Ground Run Old Bldg. x $3.25 I MNIva� I I I I I Elec. Water Heater x $2.00 w 9NISY8I I I G-as Fitting Fees: I I '0 c0001* I I I ! ! 'a lst 3 Fixtures_ x $2.00 e �' 1 �-� f 0 �Isa7M0NS I I I :Z'S I I Additional Fixtures x$ .75 i!. a '1Nfl0! I . b �+Nla°I ( ( ` I Gas Range-199,000 BTU x $5.00 Iv�j� A ® HSYMI I I I I Repairs &Alterations s"Hls I See Description; I HI I I Code sNISVII I State Surcharge .50 II son.LHl" B I TOTAL FEE $ of I The undersigned hereby makes application for a permit 91YNItl°) I I I I for the work herein specified, agreeing to all work �17801� •tl71YMI-� .do in strict accordance with the City Ordinances and ruling I I of the Department of Buildings, and hereby declare that all the facts and representations stated in this application are true and correct. .,t .pc -Signature 'Date 02/-- 2,5� Appftafti fw Fewer arA, Nba® Vema® n wd6°°® wd Airm&onan She ais and Do d= PARTIAL RATE SCHEDULE 013AYIT1t WAW4 AIM: MTZ TOTJU . Furmce Shell & Duct Work 410.00 $ Replacement of Furnace 6,00 Repairs & Alterations—up to $500.00 6,00 S Repairs & Alterations each add. $500.00 300 $ Furnace Shell & Duct Work to 120,000 BTU .410.00_ emch add. 60,000 BTU 3.UU = Replacement of Furnace 6.00 Repairs & Alterations—up to $500.00 6.00 $ Repairs & Alterations each add. $800.00 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. FDR Steam $10.00 S Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $, Each add 200 sq. ft. EDR Steam xon $ Each add. 320 sq. ft. EDR Hot Water 3.00 $ OIL BURNER—to 3 gal. per hour 6.00 over 3 gal. per hour—See Fee Schedule GAS SURFER (up to 1199,000 BTU) 5" S over I99,000 BTU See Fee Schedule GAS FITTING FLMS: NO RATE TOTAL 1st 3 Fixtures x$ 200 S r.= Additional Fixtures x .75 $-- _ Gas Range to 199AW x$ 6.00 $ State Surcharge .50 is" Fee achadmb TOTAL rm 91 5-2 lit. of Bldoz. PhoneEM-UM City of dley: The undersigned hereby makes application for a permit for the work herei. specified. agreeing to do all work in strict accordance with the City Ordinances:= and ruling of the Depat tment of Buildings, and hereby declares that -all the facts and representations stated in this application are true and correct. 'l ridley, MJnn r 1>� Owners Kind of Building Used as C To be completed about, Estimated Cost, $ _� � r 010—Ne> Permit No. Building Permit No. _ _ _ HEATING or POWERNTS--,Steam, Hot Wat* Warm Air No Trade Name Size Capacity___ _ Si, ice. E.A.R BTU— Total TU Total Connected Load Wind e4 VbeL BURNER — Tr&.e Size Cs:paclty. � 41t 7 z > ��'/ _ SUBJECT PERMIT NO. City of Fridley ® 12803 AT THE TOP OF THE TWINS BUILDING PERMIT NO�y. ti: ____ COMMUNITY DEVELOPMENT DIV. nRECEIPT ®,37 -70 i-71 1 PROTECTIVE INSPECTION SEC. 1 t�t CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF .APPROVED BY 812-560-3450 910-F15 111/15/74 JOB ADDRESS 1505 - 73rd Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 3 Jim Lund Estates SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE James Lund Construction, Inc. 2417 - 148th Avenue N.E., Anoka 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 El MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 4218" x 24' Dwelling and a 20' x 22' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before capping. Easement approved by Council. SEWER LOCATION: Service must be connected - no existing wye. 8" VCP 33' south of south property line. WATER LOCATION: Must be tapped. 12" CIP 5' south of south property line SEPERATE- TS REQUIRED HEATING, Pi. Ul�BWG AICD SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame 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 -1 1024 24.880 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 $22,095 11.05 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITFEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTI N OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE ° ,g ,/97 k—S"CPIATUREOFCONTRACTORORAUTHORIZEDAGENT (DATE) H PROPERLY VALI T I OUR PERMIT BLDG )NSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNERS NAM :James Lund Con-qtInc BUILDER: c ADDRESS ;1417 148th Ave NF Anoka ADDRESS: Same NO:./ S STREET: LOT: 8. BLOCK: 3 ADDITION: Tim Lund FCtatPC CORNER LOT: INSIDE LOT: X SETBACK:-� SIDEYARD:E-71 W-13.5 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: Single Familx Front:,;/-. Depth: 94 Height: dwelling Square Feet: • Cubic Feet: i Garage Front: 20' Depth• t21 Height: Square Feet;,/ 440' Cubic Feet: Type of Construction: Frame Estimated Cost:_ $ 32.000.00 To Be Completed: November 7.1974 The undersiy 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 (See Reverse Side For Additional Info do .) P"fL U4 I C A-17 Q/j CERTIFICATE OF SURVEY FOR: JNMES LUND Proposed 'Fop of fcundotion- 9019 DESCRIPTION Lot 8, Block 3, PropoSed JIM LUND ESTATES, Anoka CO., Minn. T I hereby certify that this is a true and correct representation of a survey of Job No. own & COlentr.0 the boundaries of the above described land and of the location of all buildings, (50 Suraeori if any, thereon, and all visible encroachments, if any, from or on said land. Bookt - Page Land Surveying • Site Planning As surveyed by me this _- — day of %-UQ. , 1914 - Civil Engineering 8816 70th Av. N. (1-94 at Boone Av. N 1 -n"" " - Scale Brooklyn Park, MN 55428 in -- Ac� Phone: 5337340 . Minn. Reg. No. lt)944 0 - ---- - 11 J y ar Dt aitzage - - Easemer�t (899.9) � (899.81 Q 4?roposea Hwree 20 42 (9002 : (9-(yoa� - - 'Road C Deno -ties iron monument Easement •. Mote • pescriP*ion invalid Unci% t90D 9� 8250 .. (900.11 plat is f fled (90(,21 (900.9) to in vrb A (qol) Denotes existing %rode Proposed 'Fop of fcundotion- 9019 DESCRIPTION Lot 8, Block 3, PropoSed JIM LUND ESTATES, Anoka CO., Minn. T I hereby certify that this is a true and correct representation of a survey of Job No. own & COlentr.0 the boundaries of the above described land and of the location of all buildings, (50 Suraeori if any, thereon, and all visible encroachments, if any, from or on said land. Bookt - Page Land Surveying • Site Planning As surveyed by me this _- — day of %-UQ. , 1914 - Civil Engineering 8816 70th Av. N. (1-94 at Boone Av. N 1 -n"" " - Scale Brooklyn Park, MN 55428 in -- Ac� Phone: 5337340 . Minn. Reg. No. lt)944 0 - ---- - 11 sew 7-16 � SCICVIC*t /VL)sr be Cox)/,f-c-7f.,V , Aja I rr,,va. 3 3 ' E, OF S, P,&10,tr ry 4,,, f Y w City of Fridley Applicattcn for Plumbing cad Gm FhVing Perelt - Dept. of Bldgs. Phone 550-3450 yy�/ ' DESCRIPTION OF dJ01lF: /.5— 7,7 Number, Kind and Locelfoa of Fixtures Loca `1 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 Beater :Up to 99.000 BTU). • • • x $3.00 $ New Ground Run Old Bldg....... x $3.25 $ Electric Water Heater............ a $2.00 $ oAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures x $2.00 $ Additional Fixtures ................ x $ .75 $ Gas Range to 199.000 BTU ...... . . . .. x $5.00 6 REPAIRS & ALTERATIONS—Refer to Code 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 tact and representations stated in this application are true and correct Fridley Minn &— 7 19 Owner Kind of Building' Used as 471 ^' To be completed about Estimated Cost, $ Old—New. Building Permit No. Permit No. Signed gy Business Phune No ROUGH .50 State Surcharge Description .........................................$ TOTAL FEE $ �� 7� 7 ► a WATER MTA. GAS N U � F M$► O r r O Q 3 f7 U C C) Base 1st 2nd _ 3rd 4th Future Coruset!kta Opaoingra Conaactood with Bawer i Now Fixture, Old Openings Ccwpool 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 Beater :Up to 99.000 BTU). • • • x $3.00 $ New Ground Run Old Bldg....... x $3.25 $ Electric Water Heater............ a $2.00 $ oAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures x $2.00 $ Additional Fixtures ................ x $ .75 $ Gas Range to 199.000 BTU ...... . . . .. x $5.00 6 REPAIRS & ALTERATIONS—Refer to Code 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 tact and representations stated in this application are true and correct Fridley Minn &— 7 19 Owner Kind of Building' Used as 471 ^' To be completed about Estimated Cost, $ Old—New. Building Permit No. Permit No. Signed gy Business Phune No ROUGH .50 State Surcharge Description .........................................$ TOTAL FEE $ �� r a X.�. �_.� sem•. K� lxr ..�,�; '�.� a. �.; � .�r�;: PARTIAL RATE SCHEDULE fbllU!VM WAMH AM: RATE TcrrAL. Fwwce Shell & Duct Work . $10.00 Replacement of Furnace 6.00 Repairs & Alterations—up to $500.00 600 $4 Repairs & Alterations each add. $500.00 300 li ZCH. WARM 1#M F1irnace Shell & Duct Work to 120,000 BTU ..$10.00 ; each add. 60,000 BTU . .. ...... 3.60 8 Repkeement of Furnace 6.00 ; Repairs & Alterations—up to $500.60 6.0.0 ; Repairs & Alterations each add. ;306.00 &W $ STEAD or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. it. F.DR Steam $10.00 $ Furnace Shell & Line --to 640 sq. ft. EDR Hot Water 10.00 $. Each add 200 sq. ft. EDR Steam I'm $ Each add. 320 sq. ft. EDR Hot Water 3.00 $ OIL BURNER—to 3 gal. per hour 6.01) $.,! over 3 gal. per hour—See Fee Schedule GAS BURNER (up to W,000 BTU) - ower 1911,0oo BF'iJ se res Schedule GAS FITTING rEES: NO RAPE TOTAL ist 3 Fixtures x$ 100 $ Additional Fixtures a .78 $ Gas Range to 10= at$ b.W $ _ State Surcharge .50 Affil TTIO1Ci � � FAN 15=71M STS S" Fe® $ic .® TMG GVZTEN ALTZRATrOPM & MZPAUS TOT= rw Co ROUGH_ T f AU D rpt. of B1dvL Phom MO -UM L� /s Os' �3 City of ridley: The undersigned hereby makes application for a permit for the work herd specified, agreeing to do all work in strict accordance with the City Ordlumee and ruling of the Department of Buildings, and hereby declares that all this fz&c and representations stated in this application are true and correct. Fridley, MJnn z— a X 1576 owner 4 Iq T ®�/f��iiG� � �! Kind of Building E-4 �4 Used as / / Arl a c I l/ tr � /A X11 To be completed about. 3— 42L % 9 Estimated Cost; $ Ol New. Building Permit No. permit No. KKA77NG or POWER PLANTS—Steam, Rot Wates, Warm Air—No Trade Name 0 I-Wtp she ?do- I Capacity -L4,000 Sq, Ft. E.D.R. l$R'(7 0� lu Total Connected Load Kind of Tit ® Z C BURNER — Trade No size 910 caped Sq. n 1r.D 1@ B7lRT Q Ilk atj � � fi' n �T'�"r, . °": .e�� `.. : F!,�➢•t ✓.AFI ad°?y..k'n :a ,'Y� a u {� t t 1, :��. ! � •'.Fr'f� � �'� < r+� � �'� � "fr�'��'r ' •�.r �'' /� '/6�f (/,���`� r+a�f9rr?[k ;'r4.gAid. `,, p�R �� Oft"-'!t^''y''P') ,r�k.rF°YA•b���� -ak'AP !q�AF?i4r "�# •tr•'1..� � } yb4 '�k i K'•,.�.j/� x .�.��,/ic y•j� /� _ i ..'�": �J] ,_l issIa.} AQy Jd��, '�� S `/r� '�Nh'� L }\✓ �i.V' I ► �RP!�1�' % M. �, k � � rfi {�/' '' �i n r ] P fr N x" q �'. Hyl q� y t � yLio'S �:� -1. +, - . - l' � `- . q..�.pprr'"e •�� Uy rr• .. r'-... �-9F:.`�,,'IS "11e3n*�� / 7�'�, �. ' �, ., .rte.-•i...-�..--•"q--�'-'.-- --+ .... �..... .._«.....-,..rr.-.- YY ...-..... 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'.1 � � . 1,4 � TM�� 4i + �..' •�99 9+w `� ••�"E•'r �e 47'+9'"I }�' 'J �'�... ...�....� ]'.wnr4.' .¢... �.�;aw�:.-.�.. y - ......1:. .-..w... �._ .... I.�...w...r..»•..� F '�,f�.'r .;r � p .� • F C � ,:: i � .i...•� (LL ......L,�..•� tf {C ' ' l�/��Jy � �' ,� / � •fi•6. �y ti ` 1 ,n1 ,� :! It `',@. G'+a•'� 0.`P�� ��;121 .. v�'�' � $'$�' rR ,fr^^ y �0 tl • ,� rw A • ' • -�. F ..r. 1' j ii _ f.� q �. '�'� �`' �-+..�w'-�„y,.;, 1.^] �`*'°°- e'••+•.dF..✓r'••Tsd.+•w- �.1.-+-`�"-1-•'-•.nn � .. �..s'r�... rr+j•...er �•.np+ ;�C'.E!°�,w,. ;b �'�t,�i:ia "i��9.$➢e ... �; 5, :' ,. ... a....�,...• ff' ,; •• 9��•, r'ir a �. +✓4 �d '} + ��+9 ei� �d tY�l N ��.i� - I"'� '/yam ] "' � •-, r t r ! ,r� �� � J �,� 9 "'"'f' �", i -«.,,.y,•.«..,- .u., u...... ,..rr.-..•...-. <i• --''Y •-•-n,.e�.... •+:'-.,.-.,,.-.+,r.s i-.,:..f,w.....q..�.,.. 4 .,, �.dw'+r•..,.�, Mr ♦R`R� 4�•-i� ,,..xmr.�•P-. , f'..,.. -r..1.. ,p�..,..,....r...dt; �'+�t+•..•..na.,»rra..n.i..,8{i+.....+.+ir,:.Ts+e%ester•,�,,,^.z.4w�n'..,_ws:....�-.�..y..rlq�r I ..,.,.. 's � �, +°f ➢ a.; 'I: 1 a40.n6 .. dVA�t Yd ,� iS65 - x.3,60 560-3450 ANOKA COUNTY 6431 UNIVERSITY AVENUE NE January 16, 1975 FRIDLEY, MINNESOTA 55432. James Lund Construction, Inc. 2417 - 148th Avenue N.E. Anoka, Minnesota 55303 Re: Structural Finals on Homes in Jim Lund Estates Dear Mr. Lund: You have been requesting finals on the homes built in Jim Lund Estates. Upon making these inspections, we have noted that there are no door closers on the door leading from the dwelling unit to the garage. This is a requirement of the Building Code and therefore you must install them. Make sure that they are capable of completely closing the door as some that we have seen are not capable enough and do not close and latch the door. This is necessary to keep the integrity of the firewall between the house and the garage. We ask for your cooperation in getting these installed on all your homes prior to your requesting finals and those with people in and already finaled must be installed on or before February 7, 1975. Upon your completion of this request, would you please supply us with the addresses of those installed in the homes that we have already make finals on so we can reinspect them. If there are any questions on this matter, please feel free to contact me at 560-3450. Sincerely, DARREL G. CLARK Community Development Adm: AGC/mh sueJEcr P T NO. '> City of Fridley 219 9 9 AT THE TOP OF THE TWINS BUILDING PERMIT f _RYCIPT NO. COMMUNITY DEVELOPMENT DIV. �7 _ L PROTECTIVE INSPECTION SEC. 1:2-369 6 / NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 7/26/93 JOB ADDRESS 1505 73rd Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 3 Jim Lund Estates. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Douglas Fagerwold 1505 73rd Avenue NE 786-2173 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Twin City Storm Sash. 10825 Greenbrier Rd, Mtka 55345 546-8160 3090 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install siding, soffit & fascia, trim 9 CHANGE OF USE FROM TO STIPULATIONS Provide adequate attic/soffit ventilation. Install smoke detectors as per UBC 1210 adjacent to all sleeping areas and in basement. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD 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 80 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 I HAVE READ AND EXAMINED THIS APPLICATION 1 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 $4,700 $2.35 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- $ 72.00 Fire SC $4.70 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE License SC $5.00 $84.05 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN E VALIDATED THIS IS YOUR PERMIT DATE SIGNATURE OF OWNER 0F OWNER BUILDER) IDATEI NEW [ ] Y)1� ? 70 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Z-6-0-6-- % ltd &x2� , Legal Description: Effective 1/1/93 Owner Name & Address: U Tel. # _Z?&f o/ Contractor: TWIN CITY STOR SASH, INC. MN LICENSE # O O Address: MINNETONKA, MN 55345 _ 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: Length Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback — Type of Construction: � Wo Approx. Completion Date: Driveway Curb Cut Width Needed: Ft. + 6 Ft = _ Side Yard Setbacks Estimated Cost: $ .moi Z'90 (Cost on Back) Ft x $ = $ DATE: 7" 9 - � APPLICANT: Tel. # Permit Fee $ o -v Fire Surcharge $ r10 State Surcharge $ SAC Charge $ License Surcharge $ .OU Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $750 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 4C